Court docket: United States District Court docket for the Center District of Louisiana
Insurance coverage Provider: 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 recognized with rheumatoid arthritis and neuropathy. His job required intensive strolling, bending, standing, and lifting, which made his situation a big problem. Seneca’s advantages had been initially permitted primarily based on medical documentation from his major care doctor and a rheumatologist confirming his disabling circumstances.
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 assessment 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 data with the intention to proceed receiving advantages past September 2020. Upon assessment, the insurance coverage firm discovered proof that Seneca’s situation had purportedly improved:
- His prognosis had modified from rheumatoid arthritis to psoriatic arthritis and neuropathy.
- By 2019, his medical data indicated that he had resumed some actions, equivalent to taking part in guitar.
- His medical doctors famous that his psoriatic arthritis was in remission and that his neuropathy was secure with treatment.
- 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 data and located inadequate proof of a situation extreme sufficient to warrant continued incapacity advantages.
Regardless of a July 2020 dedication 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 Attraction and the Court docket’s Choice
Seneca appealed MetLife’s termination choice practically a yr and a half later, arguing that his situation was persistent, degenerative, and unlikely to enhance. He submitted extra medical data, a 2020 analysis from Dr. Kevin Callerame, and statements from family and friends testifying to his difficulties.
MetLife referred the attraction 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 data, Dr. Belcourt acknowledged that Seneca had some work restrictions starting in July 2022—practically 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:
- Nearly all 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 regarded it.
- The insurer didn’t abuse its discretion as a result of its choice was primarily based on an affordable interpretation of the obtainable medical data.
Because of this, 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 struggle alone. Insurance coverage firms usually use selective medical opinions to justify chopping off advantages, even when your situation stays critical.
On the Ortiz Regulation Agency, we specialise in preventing wrongful termination of incapacity advantages beneath ERISA. Contact us on-line or name (888) 321-8131 at this time for a free case analysis. We will help you get the advantages you deserve.
Here’s a PDF copy of the choice: Seneca v. MetLife
