Court docket: United States District Court docket 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
(Be aware: This declare was not dealt with by the Ortiz Legislation Agency. The declare is being summarized right here as being academic and informational on how Federal Courts overview long run incapacity insurance coverage 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 major problem. Seneca’s advantages have been initially accepted primarily based on medical documentation from his main 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 occupationnot simply his earlier one. This overview in the end 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 in an effort 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, akin to enjoying guitar.
- His docs famous that his psoriatic arthritis was in remission and that his neuropathy was steady with treatment.
- His main 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 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 Enchantment and the Court docket’s Choice
Seneca appealed MetLife’s termination determination almost a 12 months and a half later, arguing that his situation was continual, 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 MetLifediscovering that its determination 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 determination was not binding, and MetLife had acknowledged and regarded it.
- The insurer didn’t abuse its discretion as a result of its determination was primarily based on an inexpensive interpretation of the obtainable medical information.
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 must combat alone. Insurance coverage corporations usually use selective medical opinions to justify slicing off advantages, even when your situation stays severe.
On the Ortiz Legislation Agencywe concentrate on preventing wrongful termination of incapacity advantages beneath ERISA. Contact us on-line or name (888) 321-8131 as we speak for a free case analysis. We may also help you get the advantages you deserve.
Here’s a PDF copy of the choice: Seneca v. MetLife
