Our client, Mrs. Y was covered under her employer-provided Short-Term and Long-Term Disability Insurance Policy, issued by Metropolitan Life Insurance Company (“MetLife”). Ultimately, Ms. Y became disabled from her occupation and any occupations due to cervical and lumbar radiculopathy and multilevel cervical degeneration. MetLife initially paid both Short-Term and Long-Term disability benefits under the Policy. However, two years later, MetLife terminated Ms. Y’s benefits, asserting that she no longer met the definition of Total Disability under the Policy.
Mrs. Y hired Disability Insurance Law Group to overturn the claim denial. Disability Insurance Law Group prepared a comprehensive appeal of the claim denial and submitted it to MetLife. This included obtaining sworn statements from her treating physicians, witness statements regarding her disability, and all necessary medical and diagnostic reports. Disability Insurance Law Group prepared a thorough appeal correspondence, outlining the evidence and law and attacking MetLife’s denial rationales. However, MetLife upheld its decision. Accordingly, Disability Insurance Law Group filed a lawsuit seeking Mrs. Warren’s benefits.
The lawsuit moved forward and the parties began engaging in the discovery process. Because Ms. Y obtained her Policy through her employment, her claim and lawsuit were governed by the federal statute, the Employee Retirement Income Security Act of 1974 (“ERISA”). In many cases governed by ERISA, the only information that a judge can consider during the lawsuit is the information submitted during the administrative appeals process. MetLife argued that the court could only review the information Mrs. Y previously submitted with her appeal. Disability Insurance Law Group asserted that the MetLife policy did not contain the requisite language to limit the court’s consideration. Prior to a court determination on the matter, MetLife conceded that Mrs. Y was in fact Totally Disabled under the terms of the Policy,
While Disability Insurance Law Group believes the Court would have likely ruled that its review was not limited to the evidence gathered during the administrative appeals process, we felt confident in the strength of the information that the court would have considered even if its review was limited. Fortunately for Mrs. Y, Disability Insurance Law Group prepared her appeal and submitted the appropriate information to support her disability and succeed in litigation. MetLife agreed, as it conceded its liability and ended the lawsuit with a full reinstatement of benefits.