Verizon employees should strongly consider having a close look at the long-term disability coverage they have and buying a private policy if they can afford it. Verizon's 2011 policy provides about the worst "coverage" of any I have ever seen.
Why do we say that about Verizon's disability policy?
We have just finished litigating an ERISA governed case between our client and Verizon & their insurer, MetLife. This case is still out, awaiting judgment.
This is a 2011 policy, so it is a bit outdated. However, it is, without a doubt, one of the worst policies we have seen at this office. It had the standard “own occupation” and “any occupation” distinctions. However, in this case, it was a very narrow definition of “own occupation” and a very expansive definition of “any occupation.” It also had elements of the “objective medical evidence” requirement.
This was a standard fibromyalgia claim accompanied by osteoarthritis, left hip bursitis, and diabetes. However, the unique aspect was that this provision contained a "neuromusculoskeletal and soft tissue disorder" limitation. What that means is open to debate. Theoretically, it would deny benefits to anyone with fibromyalgia, rheumatoid arthritis, arthritis, trigeminal neuralgia, or the like. In other words, it would explicitly deny the majority of disabling conditions. Fortunately, in their denial letter, Verizon & MetLife neglected to invoke this provision (whoops!). Therefore, we argued adamantly that they could not, at oral arguments on the matter, raise the issue for the first time.
Having argued the "neuro musculoskeletal and soft tissue disorder" limitation, the case then revolved around whether or not the claimant was, in fact, disabled. These were the arguments made by Verizon & MetLife:
- Dr. Smith says she is fine.
- There is no objective medical evidence she has fibromyalgia.
- She and her partner recently adopted a 3-year-old kid.
- Her parents recently moved in with her.
- She allegedly “had difficulty running.”
All of those were sham arguments. Here is how we responded, one by one, to each argument made by the insurance company:
- Dr. Smith was a frequent player for MetLife, having testified for them, in support of a denial, eight times. There is no record of him ever disagreeing. He was an internist commenting on a rheumatologist's diagnosis. He was vastly underqualified. His report was 90%+ copy and pasted medical notes. It had minimal analysis. He provided no evidence supporting his conclusion. He never discussed job duties.
- Fibromyalgia is incapable of objective medical validation. The non-existence of evidence that cannot exist does not mean somehow that the condition doesn't exist.
- She had recently adopted. However, it was her partner who was raising the child, and MetLife & Verizon knew it. In fact, we quoted them their own record explicitly stating it.
- Her parents had moved in with her to help her and her partner. MetLife & Verizon knew this because they had a record explicitly stating it. We quoted that back to them as well.
- That was a cherry picked statement. It was based on a digital medical record which carried over previous records. The original record was years ago, and it said: “she reports difficulty walking, bending, standing, and running.” MetLife & Verizon knew the claimant used a cane because of her arthritis. Someone using a cane does not run.
When the attorney for MetLife and Verizon stood up to speak, the Judge in charge interrupted him and asked him “is it really your position that disabled people can't adopt?” The attorney took the bait and tried to rationalize it. In the middle of his rationalization, the Judge again interrupted him with just “Really?” The Judge also felt compelled to criticize MetLife & Verizon’s ignorance of their “expert doctors” prior litigation history, and his obvious bias.