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Court Reinstates Claimant With Orthopedic Impairments

Friday, April 2nd, 2010

A Federal Court in Michigan has ordered Met Life to reinstate the claim of a Bearing Point employee, whose claim had been terminated on the basis of a paper review by a well known insurance company provider. The Court took issue with a number of aspects of the claim handling, in reaching the result that Met Life abused its discretion. The Court noted that even the arbitrary and capricious standard of review “has some teeth” and considered numerous aspects of the claim handling to be indicative of a financially conflicted fiduciary.

The Court was troubled by the failure to provide any consideration to the opinion of the claimant’s treating physician, as well as failure to even mention Social Security’s favorable findings. The Court also took issue with Met Life’s paper reviewing physician’s inconsistent report, and the fact that Met Life terminated the claim despite not demonstrating any improvement in the claimant’s condition, after accepting liability of the claim for years and despite worsening of the condition as revealed by medical testing.

It is clear that some courts embrace the review proceeding with some meaningful scrutiny, and thus, are able to appreciate the significant level of conflict influencing the claim process. This case highlights a common theme seen in many orthopedic disability claims. Lanier v. Met Life Mich. D. Ct. 2010

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