ERISA Long Term Disability Case Citations and references

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

Denial of Coverage Found “Arbitrary and Capricious”

A Tennessee federal district court found in favor of the plaintiff even where the plan granted discretion to MetLife, finding that the decision to deny coverage was “arbitrary and capricious.”

When Warden’s treating physician submitted a report diagnosing lumbar stenosis and raiculopathy, and also pointing that the MRI showed a “rather impressive” lumbar stenosis at L4-5, MetLife reviewed his file and advised Warden that his benefits would terminate after 24 months pursuant to policy limits.  While MetLife’s physician acknowledged radiculopathy, he stated that he believed the symptoms were substantially relieved by surgery. 

After the denial of his claim, Warden submitted additional evidence about the severity of the lumbar degeneration and confirmed that, despite neck surgery, Warden still had the same never distribution as before the surgery.  Finally, Warden’s neurosurgeon found significant degenerative disk disease in his lumbosacral spine, which caused significant nerve root compression.  Still, MetLife affirmed its denial.

The federal court addressed standard of review and found that despite the fact that the plan granted discretion to MetLife, Metlife had a duty to review the quantity and quality of evidence that it was presented with.  In this case, the Court thought that MetLife had “handpicked among the medical evidence.”  The Court concluded that based on the findings and opinions of the plaintiff’s treating physician, the MRIs, x-rays, and EMGs, the plaintiff had presented objective clinical findings of radiculopathy. 

The Court ultimately found in Warden’s favor and also ordered that MetLife pay prejudgment interest under Tennessee law unless MetLife could show that such interest “overcompensated” Warden.

Warden v. Metro Life Ins. Co., 2008 U.S. Dist. LEXIS 76007 (M.D. Tenn. August 26, 2008).