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Federal Court Finds Denial of Disability Insurance Benefits Unreasonable

Monday, December 15th, 2014

A New York Federal Court has determined that a claimant was wrongfully denied his disability insurance benefits after conducting a bench trial. Met Life was responsible for deciding the eligibility for benefits, and determined that the claimant was not disabled. In reviewing this determination, the Court found that Met Life failed to properly consider the claimant’s vocational abilities and limitations, which supported a finding that it abused its discretion in deciding the claim. Met Life determined the claimant had sedentary functional capacity, but did not undertake any meaningful effort to determine if there were occupations which the claimant were qualified based upon the functional capacity determination. Rather, Met Life denied the claim because it determined the claimant had sedentary functional capacity. This was particularly egregious where Met Life knew the claimant had only a third grade education.

Further, the Court found that Met Life speculated about the nature and degree of the severity of the claimant’s medical condition, claiming that hip surgery would resolve the limitations in functionality. As a result, the Court awarded the claimant benefits due, and permitted an application for attorneys’ fees to be made along with pre-judgment interest.

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