Met Life's 24 Month Limit for Musculoskeletal Conditions
11/29/23 • 38 min
This is the oral argument in a case involving MetLife’s two year limitation of benefits for neuromuscular, musculoskeletal, or soft tissue disorders.
In his disability claim, Penland cited several conditions. He contracted E. Coli during a business trip, leading to colon resection surgery, where part of his colon and a small intestinal cyst were removed. He also reported suffering from idiopathic gastroparesis, depression, cervical and lumbar degenerative disc disease, degenerative joint disease with osteoarthritis in both hips, IBS, cervical kyphosis, diverticulitis, restless leg syndrome, sleep apnea, psoriasis, vagus nerve damage, and altered bowel habits. Additionally, Penland underwent left hip replacement surgery.
Penland's last position was as a Regional Procurement Specialist at Continental Automotive, Inc. His role involved managing indirect procurement for plant spending under $5,000, supporting operational and tactical activities for assigned plants. He was responsible for leading efforts in payment-related issues, receiving confirmations, and handling expedites. Penland reported becoming "completely and totally disabled" on August 14, 2015, ending his tenure in this role.
The insurance company determined that the claim was subject to a two-year limitation of benefits due to the nature of the disability being categorized as a neuromuscular, musculoskeletal, or soft tissue disorder. These conditions are specifically limited under the plan. As a result, the maximum duration of benefits for this limited condition was set to expire on February 16, 2018.
The claimant asserted he had radiculopathy, but the insurance company's doctor, Dr. Pietruszka, disagreed. Dr. Pietruszka's examination found no measurable evidence of radiculopathy in the claimant's cervical and lumbar spine around December 12, 2020. Despite cervical cord compression and lumbar disc disorder, there were no motor or sensory impairments or abnormal cord signals noted. The claimant also showed improvement in mobility and responsiveness to opioid therapy. Consequently, Dr. Pietruszka concluded the claimant was not functionally impaired to an extent that would necessitate restrictions or limitations.
These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.
This is the oral argument in a case involving MetLife’s two year limitation of benefits for neuromuscular, musculoskeletal, or soft tissue disorders.
In his disability claim, Penland cited several conditions. He contracted E. Coli during a business trip, leading to colon resection surgery, where part of his colon and a small intestinal cyst were removed. He also reported suffering from idiopathic gastroparesis, depression, cervical and lumbar degenerative disc disease, degenerative joint disease with osteoarthritis in both hips, IBS, cervical kyphosis, diverticulitis, restless leg syndrome, sleep apnea, psoriasis, vagus nerve damage, and altered bowel habits. Additionally, Penland underwent left hip replacement surgery.
Penland's last position was as a Regional Procurement Specialist at Continental Automotive, Inc. His role involved managing indirect procurement for plant spending under $5,000, supporting operational and tactical activities for assigned plants. He was responsible for leading efforts in payment-related issues, receiving confirmations, and handling expedites. Penland reported becoming "completely and totally disabled" on August 14, 2015, ending his tenure in this role.
The insurance company determined that the claim was subject to a two-year limitation of benefits due to the nature of the disability being categorized as a neuromuscular, musculoskeletal, or soft tissue disorder. These conditions are specifically limited under the plan. As a result, the maximum duration of benefits for this limited condition was set to expire on February 16, 2018.
The claimant asserted he had radiculopathy, but the insurance company's doctor, Dr. Pietruszka, disagreed. Dr. Pietruszka's examination found no measurable evidence of radiculopathy in the claimant's cervical and lumbar spine around December 12, 2020. Despite cervical cord compression and lumbar disc disorder, there were no motor or sensory impairments or abnormal cord signals noted. The claimant also showed improvement in mobility and responsiveness to opioid therapy. Consequently, Dr. Pietruszka concluded the claimant was not functionally impaired to an extent that would necessitate restrictions or limitations.
These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.
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This is the oral argument in the 4th circuit court of appeals
These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.
ERISA Disability and Life Insurance Litigation - Met Life's 24 Month Limit for Musculoskeletal Conditions
Transcript
And I think the claim process that MetLife went through here
Speaker 1lends to that , because
Speaker 1the policy says that if you are subject to this limited condition , you can only get 24 months maximum of benefits . Metlife paid Mr Penlan for almost five years and what happened was , when he originally f
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