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Overcoming MetLife’s Wrongful Termination of Long-Term Disability Benefits
Our client, a 57-year-old Software Engineer employed by a global cloud-based software company, had been receiving long-term disability (LTD) benefits from MetLife for several years due to significant physical and cognitive impairments. Over time, it became clear that MetLife was growing increasingly aggressive, frequently demanding documentation and evidence to prove that our client remained unable to perform the material and substantial duties of his demanding occupation.
Despite multiple neuropsychological evaluations confirming his cognitive decline and his objectively documented functional limitations, MetLife abruptly terminated his benefits, asserting that he was capable of returning to a “sedentary occupation.” This decision was based on a series of flawed and biased tactics, including:
- Surveillance: MetLife conducted multiple rounds of surveillance in an attempt to gather evidence of functionality. These efforts were invasive and ultimately ineffective, failing to support their conclusion.
- Paper-Only Medical Reviews: The insurer relied heavily on the opinion of a paid consultant who never met, treated, or examined our client. This consultant selectively reviewed medical records to support MetLife’s desired outcome, ignoring the broader medical evidence.
- Occupational Misrepresentation: MetLife failed to analyze the actual material and substantial duties of our client’s occupation, which required a high level of cognitive functioning. They also neglected to assess whether he could perform any other work in light of his limitations.
- No Vocational or Transferable Skills Assessment: MetLife did not conduct a vocational review or transferable skills analysis, further weakening the credibility of its decision.
Faced with mounting pressure, intrusive surveillance, and unfair treatment, our client knew he needed experienced legal representation. That’s when he turned to the Law Office of Justin C. Frankel, PC to advocate on his behalf and build a strong, evidence-based appeal.
Our strategy was multi-pronged:
- Discrediting the Surveillance: We highlighted the biased and manipulative nature of MetLife’s surveillance, showing how it was designed to support a claim termination rather than uncover the truth.
- Challenging the Paper Review: We dismantled the credibility of MetLife’s consultant, revealing the flaws in a one-sided review that ignored the complexity of our client’s medical conditions. We also exposed the conflict of interest with their use of GENEX, a well-known insurance-aligned vendor.
- Providing Vocational Evidence: We retained an independent vocational expert who conducted a thorough transferable skills analysis and labor market survey confirming that our client was unable to work in any capacity given his education, training, experience and wage requirements.
- Submitting New Medical Evidence: Our client underwent updated neurocognitive testing, further documenting the extent of his impairments.
- Unwavering Treating Provider Support: We worked directly with his treating providers to produce clear, detailed statements outlining his functional limitations precluding his ability to return to work in any capacity.
Our appeal was comprehensive, meticulously organized, and left no aspect of the claim unaddressed. In the face of this overwhelming evidence and advocacy, MetLife reversed its decision and reinstated our client’s long-term disability benefits shortly after receiving the appeal.
This case is a powerful reminder that persistence, expertise, and a well-executed legal strategy can overcome even the most aggressive tactics of insurance companies.
