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Win ERISA Appeal for Software Sales Exec

Friday, May 10th, 2013

Met Life Denies Claim For Sales Exec with Eosinophilic Gastroenteritis

Our client was a 56 year old man who had been a client sales specialist for national security and intelligence programs at an international software company. The position combined high-mileage travelling with sales prospecting, client development and client retention programs in three separate multi-state sales territories. This was a high intensity sales position, working with senior officials in a highly competitive and technical field.

His responsibilities included prospecting for new customers through frequent face-to-face meetings, managing existing customer relationships, and coordinating sales activity within the assigned account regions. His continued employment demanded meeting sales quota requirements that were measured on a quarterly and annual basis.

He became ill with a rare and particularly nasty form of gastroenteritis, Eosinophilic Gastroenteritis. Treatment for this uncommon disease is often unsatisfactory, with only minor symptom relief, but there is no cure and long term outcomes are uncertain at best. The cause is unknown, and the disease leads to malnutrition and often intestinal obstruction and perforation of the gastrointestinal tract occurs. It is a miserable, relentless disease and the best that can be hoped for is management of the symptoms.

Those who suffer from Eosinophilic Gastroenteritis become ill from eating food, as their bodies reject both the food and its nutrients. Daily living is a series of episodes of pain and discomfort and frequent, urgent trips to the bathroom. While this disease can be treated to some extent with medicine, with a slight reduction in symptoms, the side effects from the medicines often cause development of new illnesses.

Our client suffered from osteoporosis and vitamin D deficiency, related directly to his inability to process nutrition in a normal fashion. The disease and discomfort led him to become anxious and depressed. A high intelligence and performance levels and a high powered career trajectory whose entire life is dramatically altered from the effects of this debilitating disease cannot help but become depressed and anxious about their future and their prospects.

He filed a claim for disability insurance benefits with Met Life and was denied. We were retained, and started by attacking Met Life’s essentially non-existent vocational analysis.

We also attacked their paper review of our client’s medical records by a nurse consultant. We provided complete medical reports and studies that were conducted on our client’s behalf, and all necessary information to show Met Life that our client simply was not able to complete the material and substantial duties of his own occupation.

Met Life never considered any of this information when making its initial inaccurate claim decision.

We submitted an appeal on behalf of our client and provided Met Life with a plethora of medical records and narrative reports from our client’s treating physicians.

After reviewing all of the medical documentation we provided, along with the applicable case law, Met Life reversed its decision on appeal, and awarded long term disability benefits to our client, who is now able to focus his attention on learning to live with an extremely debilitating disease, rather than expending his limited energies on fighting with an insurance company.

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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