Claim Remanded to Carrier to Take Corrective Action
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Claim Remanded to Carrier to Take Corrective Action

An employee who suffered a back injury was covered by long-term disability (LTD) insurance under a group policy provided by Metropolitan Life Insurance Company (“MetLife”). The plan paid LTD benefits for up to two years unless certain exceptions applied. The employee sued under ERISA claiming she was eligible for extended coverage subject to the exception that allowed such an extension for employee’s suffering from radiculopathy. She argued MetLife’s denial of further benefits was arbitrary and capricious. The Seventh Circuit reversed summary judgment in favor of MetLife holding the insurer acted arbitrarily when it discounted the opinions of four doctors who diagnosed the employee with radiculopathy in favor of the opinion of one physician who ultimately disagreed, but only while recommending additional testing that MetLife declined to pursue.

Hennen v Metropolitan Life Insurance