Our client, a 57 year old man, was a project manager in building maintenance. In October 2008, he could no longer perform the duties of his job. He was suffering from a long list of painful disabilities: herniated discs, degenerative disc disease, lumbar spondylosis, radiculopathy, chronic back pain, cervical and lumbar spine stenosis, lumbar facet arthropathy, radiculopathy, fatigue, carpal tunnel syndrome, and headaches.
Met Life had originally accepted his claim, and he received full disability benefits from October 2008 until late April 2011, when suddenly MetLife terminated his claim based solely on a paper review of his file.
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A paper review means exactly what it says: a review of the paper file. There was no medical exam, no one met him or saw him at his home or in a doctor’s office. They simply looked at some of his medical records and determined that he was no longer disabled. We are familiar with their process and the reviewer.
On December 14, 2010, our client’s claim file was reviewed by Dr. Marc Sloan, a paid consultant for Met Life who conducts many Physician File Reviews (PFRs) for Met Life short and long term disability claimants. From our research and experience, we know that every claim reviewed by Dr. Sloan that involves a spine or back condition is found not disabled, reportedly based on a lack of objective findings supporting functional limitations. Met Life had the right to have our client examined in person, but never exercised that right.
To add insult to injury, Met Life failed to conduct a proper vocational assessment. They asserted that our client would be capable of functioning in any capacity, relying on generic physical categories of occupations, rather than considering the mental and intellectual demands of the various occupations it believes our client was capable of doing.
Our client can neither sit nor stand comfortably, nor can he walk, carry anything, or do much of anything physical without a tremendous amount of pain and discomfort. We’d love Met Life to find an occupation that would be suitable for him.
On April 25, 2011, Met Life terminated the client’s long term disability claim. We prepared an appeal, with aggressive documentation of his condition and of Met Life’s complete failure to conduct an appropriate vocational assessment.
Met Life overturned its decision on December 2, 2011.
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.
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