How Roberts Disability Law Secured Reinstatement of Long-Term Disability Benefits for Client with Multiple Objective and Subjective Symptom Conditions

The Client’s LTD Claim

Our client, “Mary,” had a successful career and a strong track record for achievement in her profession when she was forced to stop working and claim disability due to a combination of symptoms arising from multiple conditions, including mast cell activation syndrome (“MCAS”), thoracic outlet syndrome (“TOS”), Chiari malformation, hypermobility, hyperactive malarial syndrome (“HMS”), postural orthostatic tachycardia syndrome (“POTS”), and craniocervical instability (“CCI”). Disability insurer, Metropolitan Life Insurance Company (“MetLife”), initially approved Mary’s long-term disability claim, but subsequently terminated benefits after several months, based on the paper-reviews of two consultants who asserted in contravention of the evidence that there were no findings of severity to warrant the placement of activity restrictions. It was clear from the consultant reports that they improperly required objective findings for symptoms and conditions that were not objectively verifiable, including pain and fatigue. They also ignored a plethora of objective evidence including documented tachycardia, flushing, facial swelling, and limited range of motion. The reviewing consultants further ignored documented cognitive abnormalities which were confirmed by formal neuropsychiatric evaluation. MetLife sent the consultant reviews to Mary’s primary physician for comment. While her physician both pointed out the flaws in the reviews and provided updated treatment records, MetLife stated that the additional material did not alter the consultant’s opinions and terminated benefits, concluding that Mary could return to her own occupation.

Our Strategy for Appealing the ERISA Denial

Our team, led by Kristin Kyle, outlined an appeal plan focusing the already existing objective support for Mary’s disability, along with additional objective testing and detailed physician support for ongoing disability. What was clear was MetLife’s willingness to ignore objective evidence that already existed, without any indication of improvement. On the contrary, Mary’s condition had further declined. On appeal, our team compiled the following (1) updated treatment records documenting ongoing flare-ups due to MCAS, and ensuing pain and extreme fatigue; (2) additional objective testing demonstrating ongoing functional incapacity; (3) multiple statements of disability prepared by Mary’s primary physician and specialists outlining both the nature and extent of her functionally impairing symptoms as well as their concurrence with the results of the objective testing in line with their experience in treating Mary; and (4) detailed declarations of Mary, family members, and coworkers offering specific examples and context as to how her medical conditions preclude full-time work. Functional testing objectively confirmed what our client’s doctors had been certifying (and documenting in treatment notes) all along, that Mary remained unable to perform even a sedentary occupation.

Outcome

As a result of our culling of both objective and subjective evidence to support Mary’s multiple conditions and correlating symptoms, MetLife was forced to reinstate ongoing total disability benefits. We represent Mary in her ongoing claim with MetLife to ensure that MetLife continues to pay her as long as she remains disabled.