We successfully represented Kathleen Boxell in her claim for LTD benefits. Boxell suffers from fibromyalgia and related conditions. Her plan, which is self-insured, is administered by Metropolitan Life Insurance Company (“MetLife”). In Boxell v. The Plan for Group Insurance of Verizon Communications, Inc. the Northern District of Indiana granted Boxell’s motion for summary judgment as to her claim for benefits. The Court held that the Plan’s decision to terminate her benefits was arbitrary and capricious, reasoning that the Plan “relied on flawed reasoning in finding that Ms. Boxell’s fibromyalgia was not disabling and in discounting the Social Security Administration’s conclusion that she was disabled [and that] it upheld its denial of her benefits based on different reasons than it initially denied them, and it failed to adequately acknowledge and justify its departure from its previous findings.”
The court also explained
- “The reasons the Plan offered for concluding Ms. Boxell’s fibromyalgia was not disabling do not support its conclusion.”
- “To the extent the Plan argues that there is no objective evidence of Ms. Boxell’s physical limitations . . . that argument is factually unsupported.”
- “To the extent the Plan seeks to discredit or distinguish [objective evidence of Boxell’s physical limitations] this argument falls short because the Plan failed to articulate those bases at the administrative level.”
- “To the extent the Plan sought to justify its conclusion that fibromyalgia was not disabling by arguing that Boxell’s own doctor excluded it as a disabling diagnosis, “[t]his statement is false, and misstates the record.”
- “The Plan did not offer any satisfactory explanation for discounting the Social Security Administration’s findings that Boxell was disabled, reasoning that the Plan’s stated reasons in litigation were either factually incorrect or distinguishable and therefore “its failure to offer any plausible reason for discounting the SSA findings is an indication that the Plan’s decision was arbitrary and capricious.”
The Court also reasoned that “there are also a number of ways of which the Plan’s reasoning was not only inconsistent over time, but self-contradictory. These contradictions not only suggest arbitrary and capricious decision making, they denied Ms. Boxell a full and fair review of her claim by misrepresenting the issues on which she would need to provide additional evidence.” These contradictions included:
- “Denying Boxell’s appeal for different reasons then it initially terminated her benefits which “not only exemplifies the definition of capricious, it implicates Ms. Boxell’s right to a full and fair review of her claim. . .” Since the Plan told Boxell in its September 16, 2011, letter that it already found she was disabled due to fibromyalgia, she had no reason to submit additional evidence on that issue. “In this regards, the Plan did not just ‘move the target’ it hid the target, giving Ms. Boxell no way to know she needed to contest the Plan’s finding on this issue.”
- “The Plan’s attempt to downplay this discrepancy by claiming that its initial statement that Ms. Boxell was disabled due to the fibromyalgia “was only a scrivener’s error and should be disregarded, but the drafting history of the letter belies this assertion.”
- “Furthermore, the Plan’s ultimate finding that Ms. Boxell was not disabled not only contradicted its initial denial letter, it was inconsistent with its entire course of handling Ms. Boxell’s claim.”
- “The Plan also appears to have changed its mind as to whether fibromyalgia was subject to the 12-month limitation of benefits.” The Court explained that an entry in the claims log on May 1, 2012, indicated that the limited disability benefit provision did not apply, “[b]ut despite the apparent change in its interpretation of this provision, the Plan never expressly acknowledged to Ms. Boxell that it had changed its mind, nor did it ever provide reasons for having done so.”
In our experience the types of manipulations and misconduct relied upon by the Court are typical of the way MetLife often improperly handles disability claims.
The case is reported at 2014 U.S. District Lexis 133991 (N.D. In. September 22, 2014).