Here's a case involving MetLife's group disability plan for Eastman Kodak. The plaintiff suffered from chronic fatigue syndrome (CFS) and was initially given full benefits.

MetLife decided to review the case and, well, they didn't do a very good job of it. The doctors they had evaluate the plaintiff didn't really use any evidence and when they did, they did so selectively.

There is no one test that can be used for CFS because it is an amalgam of several symptoms rather than a disease. So all the tests that the plaintiff's primary care physician said pointed to CFS, MetLife's docs said they didn't, claiming that there was not objective proof of the condition. And when they were asked repeatedly what the plaintiff could do to provide objective proof (remember there is no test for CFS) the question was ignored.

Brilliant. The insurance companies want a level of proof that's not possible. A definitive result from a non-existent CFS test.

The opinion, linked above, is quite a good read. The judge really goes after MetLife on some of its self-contradictions and gets after a MetLife doc's report saying it "can be characterized as shoddy and incomplete."

The whole point is that insurance companies have to be responsive and specific when they deny a claim. They have to answer the question of why the claim was denied and also explain what they would need to accept it. If they don't, something's up.
Ben Glass
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Ben Glass is a nationally recognized Virginia injury, medical malpractice, and long-term disability attorney
I am on disability with MetLife.After 3 surgerys I was forced to file for disability. All my doctors say my cervical spine problems started with an injury. MetLife says it started with a disease. Therefore, they will only pay me till I am 66 instead of the rest of my life. I have no idea what to do as I do not want MetLife to stop paying me and there is 6 years left until I am 66. Any suggestions??? Steve
by steve taylor July 28, 2009 at 06:40 PM
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