Disability Attorney Law Firm - Whatever It Takes To Secure Benefits.

Unum Sued By An Ophthalmologist And A BJC Healthcare Employee Who Both Were Denied Disability Benefits

Gregory Dell — Thu, 17 May 2012 10:40:36 +0000

Unum Life Insurance Company Of America (Unum) was sued in two different lawsuits filed in the Federal Courts of Missouri, by two plaintiffs who did not receive the long-term benefits that were entitled to them under the terms of their respective Plans that were issued and administered by Unum.

Western Division Case

In Dale L. v. Unum Life Insurance Company Of America, Administrator Of The Unum Disability Income Policy, Plaintiff through a Missouri disability lawyer filed this lawsuit due to his not receiving the disability benefits that were entitled to him under the terms of the Plan underwritten and administered by Unum. Plaintiff was employed as an ophthalmologist until he stopped working on October 25, 2000 due to degenerative and traumatic injuries that led to severe hearing loss and chronic back pain. This was shown to be caused by the Plaintiff moving an armoire.

Plaintiff filed an application for short-term disability benefits, which Unum granted. Plaintiff then filed an application for long-term disability benefits according to the terms of the Plan, which Unum initially agreed to pay. However, via letter on December 30, 2008, Unum denied further long-term disability benefits as defined in the Plan because Unum claimed the disability was caused by an illness, which limited the amount of payments according to the terms of the Plan. Plaintiff had 180 days to appeal this decision.

On March 1, 2010, Plaintiff requested an administrative review of the denial of benefits, supplying medical records and additional information to prove that he should be entitled to long-term disability benefits. However, on June 30, 2010, Unum affirmed its original decision and declared that Plaintiff had exhausted his administrative remedies. Due to this, the Plaintiff has filed this lawsuit.

Central Division Case

In Roxann P. v. Unum, the lawsuit was filed at the District Court in the Western District of Missouri Central Division because the Plaintiff seeks the withheld benefits that were to be provided under the terms of a disability insurance policy provided by her employer, BJC Healthcare, which was administered and funded by Unum.

As of May 19, 2008, the Plaintiff has ceased working due to being unable to perform the material and substantial duties of her regular occupation because of dementia that was caused by a stroke. She is also unable to perform the material and substantial duties of any gainful occupation for which she is reasonably fitted by education and has suffered a loss of 20% or more of her indexed monthly earnings.

Unum has refused to pay the benefits and issued a final decision on May 11, 2011. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit (more info about ERISA lawsuits & trials).

Relief Sought By The Plaintiffs

By filing these lawsuits, the Plaintiffs seek to gain the following relief from the Court:

A judgment declaring that the Plaintiffs are entitled to all disability benefits due to them under the terms of their Plans from the dates those benefits were terminated
A judgment declaring that all pre-judgment and post-judgment interest be applied to the benefits that were denied to the Plaintiffs
A judgment that applies punitive damages that deter Unum from committing similar actions against others in the future
A judgment declaring that all attorney fees be paid
A judgment declaring that all court costs be reimbursed
A judgment that applies other proper and just relief that the Court declares to be appropriate compensation.

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Misrepresentation By Claimant Results in Unum Disability Claim Denial

Gregory Dell — Mon, 14 May 2012 17:45:37 +0000

Unum disability claimants need to be aware that when filling out an application for disability insurance benefits it is necessary to disclose your medical history accurately and to make sure your insurance agent is doing the same. Should the insurance company discover a material misrepresentation, the policy could be rescinded, and the claimant could be required to pay back any and all benefits previously paid and then be subject to a fraud investigation. The disability carrier must be able to prove that a misrepresentation was fraudulent. Let’s take a look at recent court decision from Michigan in which a Unum disability claim denial was upheld due to a misrepresentation while applying for a UNUM disability policy.

Plaintiff applied for disability insurance with help from his insurance agent. Plaintiff initially left unanswered the medical portion of the application. Subsequently, the application was filled out by the agent answering all questions “no” except for one which asked “have you ever been diagnosed or treated for disorders of the spine.” Unum’s representative called the Plaintiff and asked him what the answer was to that question and he stated the answer was “no”. Based on that info, Unum issued the policy to the Plaintiff. The policy contained an “incontestability clause” which prevented Unum from denying benefits because of a misstatement or omission on the application 2 years after the policy effective date, with an exception for fraudulent misstatements or omissions. Plaintiff filed a claim 2 years and 3 weeks after effective date for a disease of the spine. The APS from his physician revealed that he saw the Plaintiff nearly a year before he applied for the policy. Unum’s investigations revealed that the claimant had sought treatment back in 2008. Unum denied disability benefits and rescinded his policy.

Plaintiff hired a Michigan disability attorney (not Dell & Schaefer) and sued Unum for his benefits and the agent for malpractice. The District Court granted summary judgment to Unum agreeing that there was material misrepresentation as well as to the agent (Correa) as the suit was filed beyond Michigan’s statute of limitation. The Michigan Court of Appeals affirmed the lower court’s decision stating that Unum would not have issued the policy had it known about the Plaintiff’s medical history as Unum suffered an injury when it relied on Plaintiff’s misstated medical history.

Our firm handles Unum disability claim denials on a daily basis and we always offer a free consultation to discuss your claim options.

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Aetna Is Sued For Failure To Pay ERISA Benefits To Boeing Employee For Injuries Sustained In A Shooting

Gregory Dell — Mon, 14 May 2012 12:30:39 +0000

A Washington disability lawyer filed a federal lawsuit in the District Court for the Western District of Washington, at Seattle, against Aetna Life Insurance Company (Aetna) and The Boeing Company Long Term Disability Plan (Boeing). The Plaintiff, Patrick D., worked as a real-time software engineer for Boeing, which contracted with Aetna to provide long-term disability coverage to its employees. The Plaintiff’s employment with Boeing afforded him the protections under this Plan.

In Patrick D. v. Aetna Life Insurance Company and The Boeing Company Long Term Disability Plan, Plaintiff has filed a lawsuit to recover long-term disability benefits protected under ERISA.

Case Facts Against Aetna And Boeing

Plaintiff had been employed by Boeing since 1989, including working as a real-time software engineer. He had received exemplary reviews on his performance as a real-time software engineer.

In 1971, the Plaintiff had been a victim of a shooting that caused massive damage to his face and head. As a result, the Plaintiff has had to undergo repeated surgeries over a 22-year period, including a 17-hour surgery to his head in 1996.

After this 1996 surgery, the Plaintiff’s performance had declined from exemplary to unsatisfactorily. In 2007, a performance appraisal stated that the Plaintiff was less than one-fourth as productive as the typical employee in his position. After this appraisal, Plaintiff consulted The Boeing Company’s Employee Assistance Program (EAP), who advises him to go onto disability and seek professional help to diagnose and possibly alleviate the problems that were hindering his work production. In June 2007, Plaintiff quit work and applied for disability benefits. Aetna initially granted Plaintiff’s claim for short term disability benefits.

Aetna’s Termination Of Further Benefits

However, beginning September 1, 2007, Aetna terminated Plaintiff’s short term disability benefits. Plaintiff submitted an appeal on October 31, 2007, including explanations of his condition, X-Rays, and documentation from his care providers. Aetna responded by providing an additional 10 days of short term disability benefits through September 11, 2007, but nothing more.

Plaintiff submits second appeal of the denial of benefits on March 30, 2008, along with documentation from his treating physicians and the results from a comprehensive neuropsychological evaluation conducted by neuropsychologist Glenn Goodwin, Ph.D. in February 2008. Aetna responded by restoring his short term disability benefits through the maximum duration of the short term disability period, which was December 13, 2007. Aetna also stated that his file had been returned to the claim team for “further case management.”

However, via letter on August 5, 2008, Aetna informed Plaintiff that long term disability benefits were again denied due to Plaintiff’s pharmacy not establishing that his disability was not the result of a pre-existing condition. On August 12, 2008, Aetna received a letter from the Plaintiff that included all pharmacy records to help Aetna make a determination on whether Plaintiff’s condition was a pre-existing condition or not.

On September 18, 2008, Plaintiff received a letter from Aetna, who acknowledged that the pre-existing condition exclusion did not apply to the Plaintiff’s case, but still denied long term disability benefits because the results from the February 2008 neuropsychological evaluation were determined to be too “stale” to establish Plaintiff’s disability beginning May 8, 2008.

Plaintiff submitted an appeal in April 2009 that included additional medical documentation to establish Plaintiff’s claim. Via letter on June 23, 2009, Aetna again restored benefits effective May 1, 2008. However, these benefits were again terminated as of December 13, 2009 due to Plaintiff’s disability being caused by a mental illness, which only allows for benefits to be paid for 24 months, ending December 13, 2009.

Plaintiff files another appeal that includes another detailed report by neurologist Gregory Hipskind and treatment records from his treating neurologist, Dr. Gary Stobbe. In response, Aetna had Joseph Rea, M.D., examine the Plaintiff’s medical file, though there is no evidence that Dr. Rea has any training, expertise, or experience addressing neurological issues.

Plaintiff’s Attorney Files Lawsuit Against Aetna

According to the terms of the lawsuit, Plaintiff alleges that Aetna did not provide the following to the Plaintiff:

The disability benefits that were owed to the Plaintiff under the terms of the Plan
A full and fair review of the Plaintiff’s claims for short term and long term disability benefits
Paying long term disability benefits when it was established that Plaintiff was disabled during the period he was eligible for long term disability benefits
Crediting the results of the May 2008 neuropsychological evaluation to award long term disability benefits when the results were credible enough to award short term disability benefits

Plaintiff Seeks Following From Lawsuit Against Aetna

Due to the wrongful actions committed by Aetna, Plaintiffs wants the following relief from the Court:

All disability benefits that are owed to the Plaintiff, along with accrued interest
All attorney fees and associated court costs
All other relief that the Court decides to be fair and just.

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Pennsylvania Pharmacy Owner Learns The Hard Way That Accuracy Is Everything When Applying for Disability Insurance Benefits

Gregory Dell — Fri, 11 May 2012 10:54:09 +0000

On January 28, 2011, the United Sated District Court of the Eastern District of Pennsylvania granted Berkshire Life Insurance Company of America’s Motion for Summary Judgment in Michael S. v. Berkshire Life Insurance Company of America, et. al. In addition, the plaintiff’s disability policy and FIO policy were rescinded negating Michael S.’s claims of “(1) violation of the Covenant of Good faith and fair Dealing (bad faith); (2) violation of the Unfair Trade Practices and Consumer Protection Law; and (3) breach of contract.” Further, the Court ordered Berkshire to refund the “premiums [Michael S.] paid under the Disability Policy and FIO Policy” and judgment was entered in favor of Berkshire Life Insurance Company.

Background of Michael S. and His Disability Lawyer’s Lawsuit against Berkshire Insurance

Michael S. is a licensed pharmacist. As sole owner of two pharmacies in Pennsylvania, Michael S. “sought treatment with … a licensed clinical social worker, reporting to her that he had been abusing opiates.” Having taken the opiates for some three months, Michael S. was diagnosed with a substance abuse disorder and began attending group therapy sessions to combat his abuse in May 2003. Michael S. did not go through a detoxification program nor did he seek other help for his condition. In 2005, Michael S. purchased a disability insurance policy from Berkshire in which he misrepresented his abuse problem by stating that he had not taken various drugs associated with a substance abuse diagnosis. Not admitting to previous substance abuse, Michael S. defended the omission by stating that his abuse had happened prior to the policy application from Berkshire. Wanting to keep his problem confidential, Michael S. kept his abuse to himself. Michael S. was issued his policy on February 5, 2005, and on January 13, 2007, Michael S. was a victim of an armed robbery during which he was shot in the hand. Hospitalized as result of his gunshot wound, Michael S. informed emergency doctors that he had “taken unprescribed narcotics in the past.” Afraid of a relapse in his abuse, Michael S. told doctors of his abuse problem and after treatment returned to work with limited hours. Claiming that “he suffered from extreme stress, fear and anxiety,” Michael S. hired two pharmacy assistants, and an armed security guard to protect himself, his employees and inventory, and discontinued Saturday store hours.” Michael S. also continued group and individual therapy to deal with his diagnosed post-traumatic stress disorder and added a Future Increase Option (FIO) to his disability coverage.

Michael S. Returns to Work Full Time, Voluntarily Forfeiting his Disability Benefits

After returning to work full time, Michael S. indicated that he was not disabled since he was working. Then in June 2007, one of Michael S.’s customers approached him from behind and said “stick ‘em up.” From that moment on, Michael S. said that he was unable to work. Michael S. immediately informed Berkshire of his intentions to file a disability claim, but did not provide the insurer with documentation to prove his disability until four months later after several failed attempts to procure that information from Michael S. by the insurer.

A Berkshire claims adjuster obtained Michael S.’s medical records on January 28, 2008 which documented that Michael S. had a history of opiate dependence, attachment disorders, and adjustment disorders. Other medical records from May 2007 indicated treatment for narcotics usage as far back as September 2002. With fifty-seven (57) individual and seventy-eight (78) group treatment sessions documented in his medical record, Michael S.’s honesty in his original application for Berkshire insurance was now in question, and the insurer was skeptical of the validity of its obligation to provide Michael S. with disability benefits under the terms of a policy purchased under questionable circumstances. As a result of these concerns, Michael S.’s policy was turned over to Berkshire’s legal department for evaluation.

On January 20, 2010, Michael S.’s attorney stepped in and claimed that Berkshire should honor Michael S.’s claim in that Michael S. had not intentionally deceived Berkshire and that Berkshire was acting “in bad faith by failing to provide a prompt claim investigation” in regard to Michael S.’s application for disability benefits. Berkshire claims that it is entitled to rescind Michael S.’s disability insurance policy as it was void since Michael S. had provided the insurance company with false, fraudulent, and bad faith information in his application. Ultimately, Michael S. and his attorney brought a lawsuit against Berkshire for breach of contract and bad faith based on a failure to pay disability insurance benefits under two individual disability policies. Berkshire, then, filed a Motion for Summary Judgment, and Michael S. filed a counter motion for partial summary judgment. The question before the Court in this lawsuit is whether or not Berkshire has an obligation to Michael S. to provide disability benefits in light of Michael S.’s less than honest information provided on his original insurance application.

Michael S. and his Attorney Admit Michael S. Inadvertently Provided Berkshire with False Information

Michael S. and his disability attorney admit that the information Michael S. provided the insurer was not accurate, but they also argue that Michael S. was not intentionally attempting to deceive the insurer.

Pennsylvania Court Rules on the Case

Michael S. defended his “no” responses to questions on his original disability application concerning drug abuse as he thought that since he had the problem under control it was not at issue. After lengthy argument back and forth between Michael S.’s disability attorney and the insurers’ legal team, the Court “found that [Michael S.] made material fraudulent misrepresentations in his application for disability income insurance policy,” and that “Berkshire is entitled to rescission of that policy,” as well as the Future Increase Option Policy that Michael S. had purchased in 2007. The lesson here is, always complete disability insurance applications with truthful responses.

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Can My Disability Insurance Benefits Be Denied If I Am Approved For Social Security Disability Benefits?

Gregory Dell — Wed, 09 May 2012 19:00:13 +0000

Disability Insurance Attorneys Gregory Dell and Cesar Gavidia discuss the misconception that a claimant will be approved for long term disability insurance benefits if social security disability benefits are approved.

In most cases this is a true statement, but we have been seeing a lot of people approved for SSDI benefits and then denied Long Term Disability benefits. This trend is frustrating and inconsistent as it is the disability insurance companies that often make a claimant apply for SSDI benefits.

Approximatley 72% of the people receiving LTD benefits are also approved for social security disability benefits.

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New York Federal Court Denies MetLife’s Motion To Dismiss Lyme Disease Victim’s Petition For Disability Benefits

Gregory Dell — Tue, 08 May 2012 11:46:07 +0000

In the case of Karen N. v. Metropolitan Life Insurance Company et. al, the United States District Court of New York, after hearing arguments from both sides regarding MetLife’s Motion to Dismiss the case, denied the motion in its entirety and directs the parties to appear for a status conference to determine how and when the case will proceed. And, while the Court did deny the insurer’s motion, that doesn’t mean that Karen N. will receive a favorable outcome in her lawsuit to receive her disability benefits. It does mean that the Court believes that the case deserves to be heard and ruled upon once all facts have been established.

Karen N. And Her Disability Attorney File A Lawsuit against MetLife Insurance

In February 2007, Karen N. applied to MetLife for her short term disability benefits pursuant to her ERISA insurance plan after contracting Lyme Disease as a result of a tick bite. MetLife approved her for lyme disease disability benefits in March 2007, but in July 2007, the insurer terminated Karen N.’s short term disability benefits and then upheld that decision when Karen N. appealed. Then in May 2009, Karen N. applied for long term disability benefits without any response from MetLife. Consequently, in August 2009, Karen N. filed a lawsuit against the insurance company in an attempt to get MetLife to respond and award her disability benefits. MetLife, stating that Karen N.’s claim was untimely in that she did not receive the prerequisite twenty-six weeks of short term disability required to apply and receive long term disability benefits, filed a Motion to Dismiss Karen N.’s lawsuit. Karen N. alleged that the “condition precedent to receipt of LTD benefits did not actually exist in the relevant documents,” and thus, the untimely claim isn’t relevant to her lawsuit.

Karen N.’s Disabling Condition

Employed by MetLife as a Business Systems Analyst in the insurer’s Information Technology department, Karen N. was bitten by a tick on January 6, 2007, and subsequently developed Lye Disease symptoms, forcing her to discontinue working at MetLife on February 6, 2007. MetLife initially provided Karen N. with short term disability benefits, but terminated those same benefits in July of 2007, alleging that “Karen N. had not submitted sufficient documentary medical proof” that her claimed Lyme Disease prevented her from performing her job. She was informed she could appeal this decision internally under ERISA. No time limitation for filing the appeal was noted.

Karen N. did appeal the termination of her short term disability (STD) benefits and provided material documenting her symptoms of “chills, sweats, … fatigue, joint pains, stiffness, muscle twitching, burning pains/neuralgia and electrical sensations … lightheadedness and poor balance, … cognitive problems including brain fog, confusion difficulty thinking, difficulty with concentrating and reading, and poor memory, and an excessive … need for sleep,” all consistent with a diagnosis of Lyme Disease as well as Fibromyalgia. Her doctor documented that Karen N. is totally disabled and incapable of “returning to her previous job.”

Karen N.’s Doctor and MetLife’s Doctor Disagree About Karen N.’s Ability to Work

MetLife’s independent physician consultant did not agree with Karen N.’s doctor’s assessment, opining that Karen N. should be able to work with no restrictions. Consequently, MetLife upheld its earlier denial of disability benefits to Karen N. Karen N. and her New York disability attorney alleged that MetLife terminated her short term benefits in an effort to make sure Karen N. did not receive her anticipated long term disability benefits. She was told on numerous occasions that she could not apply for the long term disability benefits until she had received all of her short term disability payments. Karen N. did receive four months of short term disability benefits, and after the four months, she applied for her long term disability benefits. With no response from the insurer, Karen N. had little choice but to file a lawsuit against MetLife and let the Court decide her financial future.

ERISA Regulations and Time Limitations for Filing a Disability Claim

ERISA requires that insurer’s provide claimants with documentation or notice if time limitations are a factor in filing claims. In Karen N.’s case, her plan did not specify a time limitation nor did the letter she received informing her of the termination of her short term disability benefits supply that time limit information. And ERISA doesn’t create limitation periods but leaves that up to plan administrators. Consequently, if any limitations exist, they should be clearly stated so that claimants know what to do when filing disability claims. After reviewing similar issues through case law, Supreme Court decisions, and statutory requirements, the District Court of New York determined that Met Life’s argument supporting a Dismissal of Karen N.’s complaint outright had no merit.

In its memorandum about this case, the Court stated that MetLife violated ERISA regulations in claiming Karen N. did not timely file her complaint, and decided that Karen N.’s claim for long term disability benefits should proceed. Stating that MetLife “cannot rest on their allegedly wrongful denial of STD benefits to preclude Karen N. from challenging their failure to consider her LTD benefits claim and that the language allegedly creating the condition precedent is ambiguous,” the Court gave Karen N. permission to not only pursue her long term disability benefits from the insurer, but the means for suing the insurer should they deny those benefits.

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Will A $38 Million Loss Result In More Prudential Disability Insurance Claim Denials?

Gregory Dell — Fri, 04 May 2012 14:54:13 +0000

Prudential is not very happy right now and disability claimants may suffer as a result. Prudential’s group insurance division, which includes long-term disability insurance policies, reported a 2012 first quarter loss of $38 million compared to a gain of $39, million a year ago. According to an article published in the Wall Street Journal, Prudential‘s chief executive said, “the company is “moving aggressively to correct” the “clear performance issues” that emerged in the first quarter in the company’s disability-income insurance business.”

What Can A Disability Claimant Expect From Prudential?

As a disability insurance law firm that has handled hundreds of Prudential disability claim denials, we are very concerned as to how Prudential plans to “aggressively” correct their $38 million loss. Our prediction is that Prudential will be performing very detailed reviews of claimants that are currently receiving benefits. It would not be surprising to see an increase in video surveillance and request for claimants to attend compulsory medical exams. Any Prudential disability claimant should pay close attention to the handling of their claim and assume that Prudential will be targeting them. The number of claims denials for disability applications is likely to increase.

If you are a Prudential claimant and it has been more than three months since you have visited your treating physician, then this may be a perfect time to schedule a follow up appointment. At the doctor visit, you must make sure that your doctor documents all of your complaints and limitations. Always assume you are being videotaped by Prudential.

Here is a link to read Prudential’s first quarter 2012 financial results official press release.

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Do You Know The Differences Between ERISA Disability Policy And NON-ERISA Disability Policy?

Gregory Dell — Thu, 03 May 2012 18:08:38 +0000

Watch our video to learn more about long term disability insurance claims which are subject to ERISA.

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A Claimant’s View of a Prudential Disability Benefit Denial

Gregory Dell — Thu, 03 May 2012 15:29:50 +0000

We always welcome our clients and other disability claimants nationwide to share their experiences regarding the handling of their disability insurance claim.

A client of our law firm that was denied long term disability benefits by Prudential Insurance Company recently posted her thoughts:

Unlucky for me, but lucky in this regard, that I rarely have the strength to even get out of bed, never mind the thought of leaving my house, and I have missed nearly every holiday event in 2 years. I guess insurance companies do not think we are allowed to live at all.

I would GLADLY invite Prudential in to my home to videotape me on a daily basis, to let them see that I can barely get out of bed to make it to the rest room, and to see how much pain I am in 24 hours a day, and how damn mad it makes me that I am so weak that I have to depend on someone to help me, or NOT be able to go see my newborn nephew who lives 15 minutes away, and NOT be able to get to Philadelphia to see specialists because I can barely drive.

I don’t know how the people who make the decisions against your case can live with themselves, or go to sleep with a clear conscience at night. It’s frightening to KNOW people are paid and trained to have no compassion or caring, and I’m too darn sick to be able to fight them.

Thank God for Attorney Dell and his very capable group, Attorney Palamara and his assistant, Kathleen Bordes, and all who have assisted in my ERISA claim. God bless you, every one! I researched ERISA attorneys when I was attempting to handle my case on my own, but far too sick to do so, and thank you for being there for me as the best ERISA claimant attorneys I could find! You are my lifesavers and I appreciate EVERYTHING you have done and continue to do for me!

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Eastman Chemical Company Employee Loses Lawsuit Against MetLife for Disability Benefits

Gregory Dell — Thu, 03 May 2012 11:56:21 +0000

In a case recently decided by an Arkansas Federal Court, MetLife prevailed in a lawsuit filed by an Eastman Chemical Company Employee. Ultimately, due to video surveillance, a lack of medical support, and the fact that the claimant had continued working at a side job (of which he had failed to inform MetLife of) while claiming to be disabled, the Court, it seems, had no choice but to agree with MetLife’s decision to deny Long Term Disability Benefits.

The fact that the claimant provided no evidence that he was still disabled from November 2009 until the time of the Court’s order, the Court had little option but to declare that Met Life “did not abuse its discretion in terminating [Freddie M.'s] benefits.” For educational purposes, let’s take a closer look at this case involving MetLife and why the claimant was unsuccessful:

Maintenance Mechanic Became Disabled in 2006

Freddie M. began working for Eastman Chemical Company as a maintenance mechanic in 1992. His job duties were that he was “‘responsible for mechanical repair of all equipment plantwide until 2004.’” Later, Freddie M. was transferred to the fork truck shop, where he worked moving large pieces of stock. In August 2006, Freddie M. took sick leave from the company and filed a MetLife Disability Application for long-term disability benefits per his Eastman Long-Term Disability Plan. Freddie M. was unable to work because of “an abnormal ENG test with 81% weakness of the right vestibular nerve”; a maximum of 20% weakness is allowable for normal functionality. Stating that he was unable to work due to “unsteadiness/dizziness,” Freddie M. continued to drive, walk, read, and take care of his household.

Upon evaluation of Freddie M.’s medical records, Met Life found that while Freddie had complained of dizziness in May 2006 to his physician that Freddie M.’s physician indicated that by July 12, 2006, due to treatment of the condition, Freddie M.’s dizziness had improved. However, Freddie continued to suffer “from loss of balance when walking or turning,” but that Freddie M.’s MRI “revealed normal internal auditory canals and normal brain condition.” Complaining that his dizziness had, in fact, worsened just two weeks after this MRI, Freddie M. had another ENG performed, which did show an 80% weakness of the right vestibular nerve. Freddie M. was cautioned not to climb ladders or engage in activities where his safety was jeopardized by his lack of normal balance. Freddie M.’s physician stated that Freddie M. could not return to work “unless he could be cleared one hundred percent with no restrictions” so Freddie M. did not return to work. The physician filled out a physician statement that confirmed his finding that Freddie M. could not return to work. Consequently, Met Life approved Freddie M.’s disability benefits application, but told Freddie M. they would require periodic updates of his medical condition.

After the awarding of benefits, Freddie M. returned to his doctor, complaining of headaches and was referred to a second physician who stated in a January 31, 2007 letter that Freddie M.”suffered from dizziness orthostasis, vertiginous symptoms, and difficulty orienting in space, and that these ailments would likely not improve and did interfere with his ability to work.” Later on February 15, 2008, Freddie M. had another ENG which showed 100% caloric weakness in his right ear, meaning his condition had worsened, or essentially, had not improved so as to allow Freddie M. to return to work. In March 2009, Freddie M. was diagnosed with severe depression and anxiety and prescribed anti depressants.

Met Life Discovers that Claimant is Working Part Time

Upon receipt of an anonymous letter forwarded to Met Life by Eastman that claimed that Freddie M. was working part time as a certified assembly tester, the insurer set up video surveillance of Freddie M. to check out the validity of the letter’s message. MetLife investigators made contact with Freddie M. to verify their findings, and Freddie M. admitted that he had begun RPZ testing and repair as a side job a couple of years before he left Eastman Chemical and continued to take projects on from time to time.

MetLife had Freddie M.’s medical records sent to a certified otolaryngologist who stated that in his opinion that he found no objective findings upon a physical examination of Freddie M.”that support the need of restrictions and limitations in work activities” after August 27, 2009. With no medical records attesting to Freddie M. suffering from vertigo and the other symptoms he previously had displayed since March 2008, the reviewer stated that Freddie M. was not disabled. This opinion was passed along to Freddie M.’s primary physician, who opined that Freddie M.’s depression and anxiety were disabling, but did not mention Freddie’s vertigo or vestibular nerve weakness.

Met Life Terminates Claimant’s Benefits and District Court Affirms that Decision

Based on the evidence available, MetLife terminated Freddie M.’s disability benefits. Freddie M. appealed, and MetLife had his file reviewed by another MetLife certified otolaryngolist, who supported the termination saying that there was no evidence that Freddie M. had “any functional limitation beyond November 19, 2009.” Pointing out that the body often can compensate when balancing mechanisms are challenged, this second otolaryngolist determined that Freddie M.’s condition had stabilized on its own over time. To take the process one step further, MetLife also had a psychiatrist review Freddie M.’s medical records and it was determined that Freddie M. was responding “nicely” to antidepressants and was currently psychiatrically stable.

Mounting a full press attack by alleging that Met Life abused its power of discretion in terminating Freddie M.’s disability benefits, Freddie M. and his Arkansas disability attorney were unable to convince the District Court that the insurer’s termination of his disability benefits was without merit. The Court summed up its long memorandum affirming Met Life’s decision to terminate Freddie M.’s disability benefits by stating that “other than [his own doctor's] statements that [Freddie M.'s] conditions were ‘permanent,’[Freddie M. and his Arkansas disability attorney] presented no evidence tending to establish that he was still disabled in November of 2009. Indeed,[Freddie M.] was working part-time as a repair mechanic. The evidence established that [Freddie M.'s] condition had improved to the point that he was no longer disabled. Therefore, MetLife did not abuse its discretion in terminating his benefits.