“Ron” called our office when MetLife terminated his long-term disability(LTD) benefits, claiming he was no longer disabled under the group LTD insurance policy provided by his employer. Because the insurance was provided through work, his claim was governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Ron suffers from post-traumatic stress disorder, depression, and anxiety; all conditions which were diagnosed and properly treated by his mental health care providers. MetLife claimed Ron’s conditions were not supported by the medical evidence. Indeed, the insurance carrier actually tried to assert that our client only filed his claim for long-term disability because he wanted an easy way out and no longer wanted to work in his occupation — the furthest thing from the truth once we came to understand our client’s situation and his disabling illness.
Our office worked with Ron’s treatment providers to obtain detailed opinions about his conditions and their patient’s disabling mental health problems. Our law office ultimately submitted an internal appeal of the long-term disability claim denial. The appeal addressed the report written by a physician paid by MetLife to review claims. It is not surprising (at least to us) that these hired gun physicians conclude that a claimant is not disabled even though the physician has never examined the claimant or even know what he looks like. We addressed the errors in the reviewing physician’s report and provided substantial new evidence to support our client’s inability to work.
The ERISA appeal we prepared succeeded in convincing MetLife to overturn it’s prior denial of the claim. Our client is now being paid the benefits that should never have been denied.