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When Your Long-Term Disability Insurer Says There’s No Evidence of …

Employees in Chicago with long-term disability claims get frustrated when the insurance company denies the claim, stating there is no evidence of their disabling condition, or that the condition prevents them from working. They get especially frustrated when they know there is such evidence. Whey insurers disclaim existence of such evidence is less often an oversight, and more often a stubbornness to pay the claim. Many times, emphasizing the evidence the insurer disclaims exists in the appeal can result in a successful appeal. But sometimes, you simply must explain this erroneous logic to a judge in litigation.

In Diaz v. Metropolitan Life Insurance Co., No. 21-cv-679, 2023 WL 112586 (D. Minn. Jan. 5, 2023), Diaz fell off a roof, injuring his right foot with a calcaneal fracture, and requiring four surgeries. Following all these surgeries, doctors diagnosed Diaz with avascular necrosis, which is death of bone tissue because of lacking blood supply. MetLife approved the long-term disability claim, but terminated benefits after 24 months, applying the insurance policy’s musculoskeletal disorder limitation. MetLife’s reviewing physician opined there was no evidence of imaging to support the avascular necrosis diagnosis, despite two CT scans, and MRI, a bone density test, and X-rays supporting the diagnosis.

After Diaz sued under ERISA § 502(a), the court ruled against MetLife and awarded judgment to Diaz, even under the arbitrary and capricious standard of review. The court reasoned that MetLife made no attempt to request any of the imaging, and if it had done so, it would have gotten the evidence it claimed did not exist. In ruling against MetLife, it stated MetLife failed to fulfill its obligations to consider the evidence in the record and cannot rewrite the record in litigation.

If an insurance company denied your long-term disability claim asserting a lack of evidence to support your claim, that is not the end of the road. Call an experienced long-term disability lawyer today.

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