Federal Appellate Court Restricts Disability Insurer, MetLife’s Application of its Limitation of Long Term Disability Related to Back Condition

For those of us handling long term disability claims for people suffering from chronic back conditions, a clause in the MetLife LTD policies has caused us much tsuris (Yiddish word, “worry”). Their policies contain a limitation for “neuromuscular disorders” providing coverage for only two years for disorders of the spine unless one of six exceptions are objectively proven. Simply stated, this clause impacts a large pool of disability claims, since many of the disabled have back conditions that impair their ability to sustain static positions required for most work, such as prolonged sitting or standing. Some long term back conditions linger despite an absence of radiographs or MRIs, or EMGS documenting evidence of progression. A whole other category of disability, that caused by chronic pain and the side effects of necessary narcotic pain medication, is often overlooked by the insurer eager to deny claims.

We have handled many long term disability cases involving “failed back syndrome” where our clients have neuro-stimulators permanently installed in their backs to help them manage pain. Despite that evidence of the severity of their despairing condition, the absence of an “objective” test showing the precise cause of the spinal dysfunction was used to deny their claim.

Fortunately, the 7th Circuit Court of Appeals recognized the significance of various elements of proof establishing the existence of a neuromuscular disorder which qualifies under the exceptions to the MetLife limited coverage. While MetLife emphasized that there were some equivocal test results showing ongoing radiculopathy (an exception to the limit), the Court of Appeals considered the clinical examination results of the claimant’s own specialists, ongoing consistent testing which aligned with the disorder and past positive EMGs as the objective evidence MetLife arbitrarily disregarded. They reversed the District Court in Hennen v. Metro. Life Ins. Co., 2018 U.S. App. LEXIS 26114 (7th Cir. 2018). This decision fortifies that the insurers must not require only a certain “objective evidence” to establish the necessary proofs.

The Court went further to point out the consistency in the evidence supporting the impairment, particularly troubled by MetLife’s failure to consider that “every physician who examined Hennen after her 2012 spine operation concluded that she had radiculopathy.” Id. at *16 and criticized MetLife’s self-serving gamesmanship by selecting only their physician who favored their position.

We are pleased that the Seventh Circuit saw through the veil of MetLife’s allegations that Hennen no longer qualified for disability. We see all too often that insurers latch onto one piece of evidence, ignoring all else, as they rush to deny bonafide claims of the disabled. We are constantly in the trenches with the insurers, advocating for their fair consideration of all of the evidence that we present on our clients’ behalf. They must be held accountable to their fiduciary obligation to each of our clients.

Thank you for reading our post! We report on interesting developments in the law of disability. See www.disabilitycounsel.com for information on our New Jersey disability law firm.

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