Courtroom: United States District Courtroom for the Center District of Louisiana
Insurance coverage Service: Metropolitan Life Insurance coverage Firm (MetLife)
Claimant’s Employer: HP, Inc.
Claimant’s Occupation: IT Administrator
[Note: This claim was not handled by the Ortiz Law Firm. The claim is being summarized here as being educational and informational on how Federal Courts review long term disability insurance claims.]
Jason Seneca, an IT administrator for HP, Inc., started receiving long-term incapacity advantages from MetLife in September 2018 after being identified with rheumatoid arthritis and neuropathy. His job required in depth strolling, bending, standing, and lifting, which made his situation a major problem. Seneca’s advantages had been initially accepted based mostly on medical documentation from his major care doctor and a rheumatologist confirming his disabling situations.
Nevertheless, after two years, MetLife reevaluated his declare beneath a stricter definition of incapacity, requiring him to show that he was unable to work in any occupation, not simply his earlier one. This overview finally led to the termination of his advantages in September 2020.
Why MetLife Terminated Seneca’s Advantages
MetLife notified Seneca in January 2020 that he wanted to supply up to date medical information with a view to proceed receiving advantages past September 2020. Upon overview, the insurance coverage firm discovered proof that Seneca’s situation had purportedly improved:
- His analysis had modified from rheumatoid arthritis to psoriatic arthritis and neuropathy.
- By 2019, his medical information indicated that he had resumed some actions, reminiscent of taking part in guitar.
- His medical doctors famous that his psoriatic arthritis was in remission and that his neuropathy was secure with remedy.
- His major care doctor didn’t place him on any work restrictions on him after September 2020.
- An impartial doctor, Dr. Mahdy Flores, reviewed the information and located inadequate proof of a situation extreme sufficient to warrant continued incapacity advantages.
Regardless of a July 2020 willpower by the Social Safety Administration (SSA) that Seneca was disabled, MetLife decided that the SSA’s findings weren’t binding by itself decision-making course of.
Seneca’s Enchantment and the Courtroom’s Choice
Seneca appealed MetLife’s termination choice almost a 12 months and a half later, arguing that his situation was persistent, degenerative, and unlikely to enhance. He submitted extra medical information, a 2020 analysis from Dr. Kevin Callerame, and statements from family and friends testifying to his difficulties.
MetLife referred the enchantment to a different impartial doctor, Dr. Roger Belcourt, who additionally discovered no disabling impairment as of September 2020. Nevertheless, in 2022, after reviewing extra medical information, Dr. Belcourt acknowledged that Seneca had some work restrictions starting in July 2022—almost two years after MetLife terminated advantages.
The courtroom dominated in favor of MetLife, discovering that its choice was supported by substantial medical proof. The decide emphasised that:
- The vast majority of Seneca’s treating and reviewing physicians, together with impartial evaluators, discovered no extreme restrictions on the time of termination.
- The SSA choice was not binding, and MetLife had acknowledged and thought of it.
- The insurer didn’t abuse its discretion as a result of its choice was based mostly on an affordable interpretation of the obtainable medical information.
In consequence, Seneca’s lawsuit was dismissed.
Going through a Lengthy-Time period Incapacity Denial? Get Authorized Assist.
In case your long-term incapacity advantages have been denied or terminated—particularly if an insurer claims your situation has improved regardless of your ongoing struggles—you don’t need to battle alone. Insurance coverage firms typically use selective medical opinions to justify chopping off advantages, even when your situation stays critical.
On the Ortiz Regulation Agency, we specialise in combating wrongful termination of incapacity advantages beneath ERISA. Contact us on-line or name (888) 321-8131 right now for a free case analysis. We can assist you get the advantages you deserve.
Here’s a PDF copy of the choice: Seneca v. MetLife
