Orthopedic Disability Claims

Frankel & Newfield Overcomes MetLife Denial for Systems Services Field Engineer

Our client, a 59-year-old Systems Services Representative/Field Engineer/Major Incident Manager, enjoyed a successful career working for a major international technology and business consulting firm. He suffered from numerous aliments due to degenerative disc disease, cervical (C6-C7) and lumbar disc herniation, spinal stenosis, cervical and lumbar radiculopathy, epidural fibrosis (L4-5, S1), lumbar spondylolisthesis, bilateral hip/pelvis osteoarthritis, degenerative synovial cyst (L4-L5), arthritis of the spine, lower back pain with right hip/buttock pain that radiates down anterior leg, para labral cyst on right hip, labral tear of right hip joint, atrophy of right arm, hypertension, peripheral neuropathy, chronic pain, sleep apnea, poor balance, gastroesophageal reflux, high cholesterol, essential tremor of upper extremities, grand mal and petit mal seizure disorder.

He lived for many years with a great deal of pain, and had done his best to continue to work, but at a certain point, his conditions made it impossible to perform the duties of his position. In addition, he took a number of medications, and the side effects took a toll on his cognitive abilities.

When his physicians advised him to stop working and to apply for short term disability, MetLife approved his short term claim and agreed that he was disabled from performing his own occupation on a full-time sustained basis. After his short-term disability claim was exhausted, his physicians did not release him to return to work and advised him to apply for long term disability, which was subsequently denied by MetLife, despite no change in his medical condition.

MetLife based its determination on a faulty vocational analysis which miscategorized our client’s occupation and failed to appreciate his functional deficits. He had been reassigned to lighter duty as a Major Incident Manager, but was not able to perform the necessary tasks of that position. MetLife erroneously misconstrued his duties as a Major Incident Manager by only acknowledging the sedentary duties of the occupation.

On appeal, we worked closely with our client in establishing evidence with his employer delineating his day-to-day occupational duties as a Major Incident Manager, reinforcing the fact that his own occupation by no means could possibly considered “sedentary.” Even with the reassignment of his occupation as Major Incident Manager, MetLife refused to acknowledge his restrictions and limitations.

We attacked MetLife’s purported “independent” peer reviewing consultants, and the well-known pro-insurance company vendors MetLife typically retains to bolster its claim denials.

Additionally, we developed powerful arguments revealing MetLife’s bias and egregious conduct. These arguments included MetLife’s failure to consider our client’s:

• Subjective complaints of impairment;
• His overall co-morbid conditions;
• The impact of the side effects of the medications he is required to take;
• His own occupation;
• The nature of the institution where he was employed and
• The general characteristics of his position.

Frankel & Newfield was proud to reverse MetLife’s decision through our aggressive representation, the use of supporting materials documenting the material and substantial duties of our client’s job and our skillful highlighting of the biased nature of the medical reviews created by its vendor. By working harmoniously with our client for this collaborative effort, success was achieved.

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