Bartolic Law helped many clients get claims paid by MetLife. We helped a former management consultant suffering from Fibromyalgia demonstrate a physical disability, avoiding MetLife imposing a 24-month limitation on mental health disabilities. In one accidental death insurance case, a client’s family member died of a cocaine overdose, and MetLife declared it was not an accident. With photos and videos, we showed the insured laid out work clothes for the next morning, set an alarm clock, and even pre-packed meals to take to work. We persuaded MetLife the overdose must have been accidental given the intention to go to work the next morning. In a Fentanyl overdose case where nobody knew how the insured ingested the drug, we used visual evidence to prove the insured must have ingested the drug orally, due to lack of any trace of intravenous or transdermal administration. Following up on a witness statement the insured complained of a headache hours before the death, we tracked down an Aspirin bottle with Fentanyl tablets inside, which we used pictures to show the two tablets look nearly identical, resulting in presumptive accidental ingestion. Result: claim paid.
In a long-term disability case, MetLife contended our client could transition to a sedentary job at the Any Occupation stage, ignoring his co-morbid obesity resulting from the spine disorder. We took photos and videos showing the client’s bedsores from limited mobility, and use of a walker to move about the house.
MetLife aggressively denies accidental death insurance claims, claiming the death was not accidental, or that an exclusion applies. In one instance, we found in MetLife’s file notation that a denial would only be defendable if a deferential standard of review applied, as the policy lacked a drug overdose exclusion. Upon highlighting this, MetLife paid the claim.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)