Met Life, one of the largest insurers of ERISA long term disability insurance claims, has been found to have abused its discretion in terminating benefits to a Verizon employee, once her claim was reviewed under the any occupation definition of disability.
Plaintiff was employed as a Customer Account Manager for Verizon, from 2000 until August 2005, when she became unable to work due to an injury to her head, causing a concussion and traumatic brain injury. Her ERISA disability claim was paid for 24 months (first 12 months of short term disability benefits, then another 12 months of long term disability benefits). Thereafter, Met Life reviewed whether she remained disabled under a standard of disability which evaluates whether one can perform the duties of some other occupation taking account of one’s education, training, experience and prior earnings.
In determining that plaintiff was not disabled, Met Life relied upon a review performed by doctors who never treated, evaluated or examined the plaintiff; instead, they simply reviewed medical records, and determined that there was “no objective evidence” to support continued impairment. This objective evidence term did not exist in the policy, and was effectively added to the plaintiff’s claim requirements without notice. The Court held that in taking the position that plaintiff failed to submit objective medical evidence to support her claimed functional limitations, Met Life ignored the definition of disability in the plan, and violated ERISA.
Further compelling the Court’s determination was Met Life’s failure to consider the finding of disability made by the Social Security Administration, despite Met Life requiring the plaintiff to pursue Social Security disability benefits.
Unfortunately, rather than grant her benefits, the Court remanded the claim back to Met Life for further consideration of the claim.