MetLife Denial Reversed on Appeal: A Diagnosis of Radiculopathy is Exempt from 24 Month Limitation Period for Neuromusculoskeletal Disorders
Kelly Iley, a pharmacist for Kroger Co, was insured under the company’s group long-term disability policy with Metropolitan Life Insurance Company (MetLife). In June 2001, Ms. Iley was diagnosed with lumbar disc disease.
Ms. Iley stopped working in May 2001 and had a discetomy in July 2001 and a fusion surgery in May 2002. She continued to suffer from back pain and filed a total disability benefits claim in November 2001. MetLife initially approved Ms. Iley’s claim but terminated benefits in July 2004, noting the plan’s 24 month limitation period for neuromusculoskeletal and soft-tissue disorders. On appeal, Ms. Iley’s treating physicians submitted statements that she was totally disabled due to radiculopathies. MetLife upheld its denial of benefits and Ms. Iley filed suit in the U.S. District Court for the Eastern District of Michigan, seeking reinstatement of benefits under the Employee Retirement Income Security Act (ERISA).
Upon reviewing the case, Judge Sean F. Cox found that MetLife ignored Ms. Iley’s treating doctor’s diagnosis of radiculopathy and wrongly denied long-term disability benefits under ERISA. Judge Cox found that the plan’s 24 month limitation period did not apply to Ms. Iley and ordered reinstatement of her benefits. The court also awarded Ms. Iley over $20,000 in attorney fees.
Kelly Iley v. Metropolitan Life Insurance Co., et al., No. 2:05-cv-71237, E.D. Mich.; 2007 U.S. Dist.
