A Federal Judge has determined that Met Life's decision to terminate long term disability insurance benefits to a claimant suffering from cervical radiculopathy was arbitrary and capricious. The Court, in Michigan, determined that Met Life selectively credited beneficial evidence and opinions while rejecting contrary evidence without sufficient explanation.
The claimant initially became disabled in 2007 after suffering an injury, which prevented her from working as a baggage handler. Payments were awarded by Met Life for the 36 month period in which they evaluated her ability to work in her own occupation. Thereafter, benefits were terminated when Met Life determined that she could engage in work that would disqualify her from benefits under an any occupation standard of disability. Thus, her long term disability insurance benefits were terminated in 2010.
The claimant appealed, and provided additional medical support demonstrating continued entitlement to benefits. Met Life utilized by Philip Marion, a well known insurance pandering medical reviewer, to perform a paper only review of her medical records. He concluded that she had functional capacity, and based upon that review, Met Life conducted a vocational review which found jobs she could work.
In reviewing the determination to terminate the long term disability benefits, the Court found that Met Life relied on irrelevant evidence while ignoring evidence suggesting impairment. The Court was also troubled by Met Life's reliance upon the denial of benefits by the Social Security Administration,
Because the determination of the claimant's functional capacity was flawed, the Court found that Met Life's subsequent vocational determination was also flawed and could not support the termination of her claim. The Court was also critical of Dr. Marion's review, noting that he ignored numerous pieces of medical evidence in formulating his conclusion.
The Court completed its excoriation of Met Life by finding that its "entire review process -- from the initial handling of Plaintiff's post-36 month LTD benefits claim through the appeal -- appears to have been a result-oriented, slapdash affair designed only to ignore inconvenient facts and reach a pre-ordained objective of denying Plaintiff's claim." Thus, the Court found that Met Life did not engage in a deliberative and principled reasoning process and reversed the termination of benefits.
Magdziak v. Met Life