Our client had initially engaged us to file an ERISA appeal for her denied claim for long term disability insurance benefits under her Met Life policy. Her claim had been denied initially during the own occupation analysis of her claim. She had been the head of Human Resources at a college, a job requiring significant cognitive and physical stamina. She was in her 50s and suffered from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and was substantially impaired in her functionality. We successfully appealed her ERISA disability insurance claim, securing medical support, test results and additional information. Met Life accepted her claim and paid benefits.
Having helped her navigate her claim thereafter, she recently faced the transition of her claim from own occupation to an analysis under her policy of whether she could engage in performing “any occupation” – a broader definition that often leads to a claim termination.
Often, after 24 months of benefits, this change of definition exists in group long term disability insurance policies (LTD). This analysis undertaken by Met Life was to determine if our client had the ability to perform the duties of any occupation that she was “qualified” for by virtue of her education, training, or experience.
She continued to suffer a myriad of impairing symptoms, including pain, fatigue, and cognitive decline. Her cognitive issues were manifesting directly throughout her life. Her physical impairments due to her ME/CFS was significant and prevented her ability to engage in any meaningful activity. Most of her days were spent at home, and with very limited activity. She could not predictably engage in any type of activity or sustain any effort. Nonetheless, Met Life questioned the severity of her continued impairment.
We began to secure medical evidence which would demonstrate her inability to perform the duties of any work, on any sustained or predictable basis. We secured CPET (Cardio Pulmonary Exercise Testing) to help demonstrate that she could not produce the necessary energy to engage in activities of daily living, let alone a work day. This two-day test protocol has been found to be the “gold standard” for providing objective evidence of impairment in ME/CFS cases.
Coupled with securing cognitive testing which showed deficits across a wide swath of cognitive functions, the support was overwhelming and compelled Met Life to concede that our client’s claim remains payable. We are pleased that our client can now focus on her health, to seek some level of improvement to her quality of life.