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MetLife Will Grab Onto Anything To Deny Your Claim

Here's a recent case involving MetLife and some of their ridiculous procedures. The plaintiff, Kaufmann, was a Senior Project Manager at Siemens who suffered from severe chronic back pain that severely limited her physical abilities. Her job entailed traveling around and giving IT support to various hospital systems along with the normal tasks of working in an office, carrying files, bending, stooping, etc.

Anyways, her doctors opined that she couldn't work anymore and she submitted a claim to MetLife with all her records and a detailed explanation of her job description and duties that put it in the "light work" category. MetLife received the information, saw that she was a "Senior Project Manager" and assigned the job a "sedentary" classification, basing the classification on the Department of Labor's employment dictionary. Unfortunately for MetLife, Kaufmann's policy clearly states that the definition of "occupation" is what the claimant actually does, not what their title is.

MetLife forwarded all the medical records to a doc for review and the doctor comes back and says that, although she has limitation, she can work in a sedentary position and should be able to return to work: claim denied. Kaufmann gets the denial and goes and gets an occupational therapist to run exhaustive testing to show that she can't perform her job. They appeal the claim with the new medical info and MetLife sends it to a second doctor. The second doctor declares that Kaufmann has ZERO limitations that would preclude her from working in ANY CAPACITY. That's like saying she could work construction if necessary. The doctor claimed that there was no "objective evidence" and didn't even address the new test results from the occupational therapist.

So MetLife's first doctor says that there are limitations but that Kaufmann can do sedentary work while the second doctor says that she has no limitations whatsoever. All this while her light work job is being referred to as sedentary. Neither doctor received any job description but somehow they were able to determine whether or not Kaufmann could do her job. MetLife denied the claim again, ignoring their first doc and relying completely on the second.

Luckily, the court saw exactly what MetLife was up to and declared their denial arbitrary. They didn't even attempt to reconcile the conflicting opinions of their two reviewers, not to mention their intentional misreading of the plan that lead to their typifying the occupation as sedentary. Just another reason why it's important to have a skilled ERISA attorney on your side, so you can deal with companies like MetLife.

Check out the full opinion on this MetLife ERISA denial case.

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