Articles Posted in MetLife

The United States Court of Appeals for the Ninth Circuit in Salyers v. Metropolitan Life Insurance Company, ___ F.3d ___, No. 15-56371 (9th Cir. September 20, 2017) recently rejected an attempt by MetLife to avoid paying a $250,000 death benefit to a widow who had purchased $250,000 in life insurance coverage on her husband prior to his death. In what has recently become an increasingly common scenario, Susan Salyers purchased $250,000 in life insurance on her husband Gary Wolk through a MetLife plan offered by her employer and timely paid all of her premiums on the policy, but MetLife refused to pay the full amount of the death benefit after discovering that Ms. Salyers had not provided the required “evidence of insurability” when purchasing the insurance coverage.

According to the fine print in the MetLife policy, Ms. Salyers was required to submit “evidence of insurability” (proof that her husband was in good health) before any life insurance coverage greater than $50,000 would take effect. However, Ms. Salyers had originally applied for only $30,000 in coverage, and through a clerical error, her employer enrolled her in a policy providing $500,000 in coverage, for which she paid the full premium amounts to MetLife via payroll deductions. At the next open enrollment period, Ms. Salyers elected $250,000 in coverage for her husband, but no one ever told her that she needed to provide “evidence of insurability” in order to obtain this coverage. Nonetheless, MetLife happily accepted her premium payments while never insisting on “evidence of insurability.”  Two weeks later, Ms. Salyers’ husband died.

After the death of her husband, Ms. Salyers submitted a claim to MetLife for the life insurance that she had purchased, but MetLife refused to pay the $250,000 benefit, insisting that she had failed to meet the terms of the policy by not submitting “evidence of insurability.” This was the first time Ms. Salyers had ever heard about a requirement for “evidence of insurability.” Neither the employer nor MetLife had notified Ms. Salyers that she needed to complete further paperwork to be eligible for the life insurance coverage. After MetLife denied the claim, Ms. Salyers sued Met Life, asserting that by accepting her premium payments in the amounts requested for the $250,000 coverage and failing to request evidence of insurability, it was bound to pay the $250,000 death benefit. At trial, judgment was entered in favor of MetLife, and Ms. Salyers appealed to the Ninth Circuit.

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Scleroderma.

According to the American College of Rheumatology:

WHAT IS SCLERODERMA?

O’Ryan Law Firm, on behalf of Plaintiff, Jilian F., recently filed a federal lawsuit against Metropolitan Life Insurance Company (“MetLife”) in an attempt to reinstate the Plaintiff’s disability benefits claim. The Plaintiff was employed as a Marketing Communication Specialist with Landis + Gyr, which made her eligible for disability benefits under the Cellnet + Hunt Employee’s Welfare Benefit Plan (the “Plan”). In Jilian F. v. Metropolitan Life Insurance Company and Cellnet + Hunt Employee’s Welfare Benefit Plan, the Plaintiff filed a lawsuit to gain the long-term disability benefits she was entitled to under the terms of the MetLife policy.

Facts of the Case Against MetLife

Plaintiff was employed by Landis + Gyr until she became disabled in 2011 due to the disabling effects of Thoracic Outlet Syndrome, cervical degenerative disc disease and cervical radiculopathy, severe neck pain, fibromyalgia, carpal tunnel syndrome, and paresthesia.

Plaintiff filed an application for long term disability benefits and was paid disability benefits by MetLife from August 2013 to September 17, 2014.

MetLife Terminates Long-Term Disability Benefits

On September 17, 2014, MetLife wrongfully terminated the Plaintiff’s long-term disability benefits. Plaintiff, represented by the O’Ryan Law Firm, then filed an administrative appeal with MetLife challenging the termination of her disability benefits. With this appeal, the Plaintiff included significant medical evidence to prove that she continued to meet the definition of Disabled under the MetLife policy. However, MetLife refused to overturn their decision to terminate the benefits. As a result, the Plaintiff was forced to file a lawsuit under ERISA in federal court against MetLife to obtain the benefits due her under the MetLife policy.
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