In a recent case involving MetLife that was reported in "MetLife Will Grab Onto Anything to Deny Your Claim," the insurer used egregious tactics to deny a disability claim, tdemonstrating what it will do to delay and frustrate claimants. In this particular case, Ms. Kaufman was a Senior Project Manager at Siemens whose job duties included travel to give IT support to various hospital systems along with her usual office tasks such as carrying files, lifting, bending, and stooping.
Unfortunately, Ms. Kaufman suffered severe chronic back pain that was seriously hampering her ability to do her job. Her doctors opined that she could no longer work in her present capacity so Ms. Kaufman submitted a disability claim to MetLife accompanied by her medical records and a complete job description.
Upon receipt of the records, MetLife apparently saw that she was a Senior Project Manager and assumed it was a sedentary job, obviously ignoring the detailed job description. Under MetLife’s own policy, however, it clearly states that an “occupation” is defined by the work the claimant actually performs, not what their title implies.
Pursuant to its own procedures, MetLife forwarded the medical records, but without the job description, to a doctor of its choice who reported that although Ms Kaufman had some limitations, she could clearly return to a sedentary position. Consequently, MetLife denied the disability claim.
Ms. Kaufman, though, went to an occupational therapist whose thorough testing clearly indicated she could not perform her job. Ms. Kaufman appealed the denial and submitted the new records to MetLife, which promptly sent them to a new physician who opined that, incredibly, Ms. Kaufman had no physical limitations whatsoever and could work in any capacity. Like the first doctor, the new doctor ignored the findings and test results of Ms. Kaufman’s health care providers and ignored her job description enabling MetLife to use the new doctor’s report to again deny Ms. Kaufman’ claim.
The court, however, saw through MetLife’s ruse and declared that MetLife’s denial was arbitrary stating that the company never attempted to reconcile the two, conflicting opinions of its own doctors and ignored, or intentionally misread, their own policy that resulted in their classifying Ms. Kaufman’s occupation as sedentary.
This is just one example of why a skilled ERISA attorney is essential so that arbitrary denials like this cannot stand.