Ms. A became a kindergarten teacher in 2001. She loved her job and each of the children she taught throughout the years. Unfortunately, in the winter of 2014, Ms. A. was in a serious car accident. She was stopped at a light when a pick-up truck struck her car from behind going approximately 45 miles per hour. Her car was propelled into an intersection and struck by another vehicle on the driver’s side. Ms. A broke her pelvis, left hip, left leg, and left arm and shoulder. She had multiple surgeries and was in the hospital for several months. She was unable to return to her class room for the rest of the school year and had to undergo physical therapy throughout the summer. Ms. A hoped to be able to return to work the following year. However, despite the surgeries and physical therapy, Ms. A remained in constant and overwhelming pain. She had difficulty walking unassisted and could not sit, stand, or walk for prolonged periods of time. Even minor activity increased her pain to intolerable levels. It became clear that Ms. A would never be able to return to the classroom. As such, Ms. A applied for long-term disability benefits under the terms of her Metropolitan Life (“MetLife”) Disability Insurance Plan. After a long investigation, MetLife ultimately approved Ms. A’s claim, finding that she met the definition of Total Disability as she was “unable to perform the duties of her Regular Occupation” as a kindergarten teacher. Subsequently, MetLife required Ms. A to apply for Social Security Disability Income (“SSDI”) benefits and she was ultimately determined by the Social Security Administration to be unable to maintain gainful employment in any occupation. In accordance with Ms. A’s MetLife policy provisions, MetLife began deducting the full amount of Ms. A’s SSDI benefits and her young daughter’s dependent SSDI benefits from each of Ms. A’s monthly MetLife disability benefit checks and required her to pay all back benefits received from the Social Security Administration to MetLife.
After receiving benefits from MetLife for approximately 18 months, Ms. A received a letter from MetLife, explaining that after 24 months of disability, her definition of Total Disability will change from the inability to perform the material and substantial duties of her regular occupation, to the inability to perform the substantial and material duties of any occupation which she is qualified to perform given her education, training, and experience. Given her extensive medical records, her physicians’ opinions that she could not work in any occupation, and her SSDI award, Ms. A was not concerned about the change in definition. However, after receiving benefits for 23 months, MetLife sent Ms. A a letter stating that it determined that she was not disabled from any occupation and actually provided a list of three occupations it asserted she could perform. It was explained that Ms. A would receive one additional benefit check and then her benefits would be terminated. Ms. A was both confused and terrified. She relied on her monthly benefits to pay her bills and support her child.
At the insistence of her physician, Ms. A contacted our Firm and we agreed to represent her in appealing MetLife’s decision. We obtained a copy of her claim file, including all internal notes, emails, reports, and documents generated in the course of MetLife’s investigation. This included a reviewing physician report and a vocational analysis. It was clear that MetLife failed to provide the reviewing physician with all of Ms. A’s medical records. We sent Ms. A to an independent physician, who reviewed all of her records and MetLife’s medical review report, examined her, and performed a Functional Capacity Evaluation. He opined that Ms. A was unable to maintain gainful employment in any occupation. He also explained that the medical review report was medically unsound and based on incomplete information.
We also had Ms. A undergo a vocational analysis by a truly independent expert. She opined that given Ms. A’s limitations, she did not possess transferable skills that would allow her to be employable in any job. She also provided a comprehensive analysis as to why Ms. A could not maintain employment in the three occupations alleged by MetLife. Further, we obtained Ms. A’s Social Security file which also contained an independent vocational analysis and an independent medical records review report, both supporting Ms. A’s disability from any gainful occupation. We further obtained sworn witness statement from Ms. A and her family members detailing her limitations. All of this information was submitted with a comprehensive appeal correspondence. Within 45 days, MetLife overturned its decision, paid Ms. A all back benefits owed and continues to pay her monthly disability insurance benefits.
If your or a loved one are considering filing a claim for disability benefits, have already filed a claim but are still awaiting approval, or have received a denial of benefits please feel free to contact Disability Insurance Law Group at (866) 363-3628 for a free consultation or visit our website at www.Dilawgroup.com for additional information. Disability Insurance Law Group handles claims nationwide. We have successfully handled thousands of disability claims and are very familiar with the delay and denial tactics utilized by these companies.