Groves v. Metro. Life Ins. Co.

In this 2005 case, the Appellant employee appealed from the U.S. District Court which granted summary judgment in favor of the insurer after the employee challenged the insurer’s termination of his long term disability benefits by filing a claim under ERISA.

The insurer reviewed the employee’s extensive medical records and then sent them to an independent physician consultant. This independent physician reported that the employee’s conditions prevented him from working as a truck driver, but the employee retained functional abilities with sedentary to light work capacity level. The insurer then asked the employee’s treating physician to comment on the independent physician’s report. The treating physician’s opinion was that the employee may have been able to perform at the sedentary level. However, the treating physician also did not think that the employee was employable, and remained of the opinion that he should have been considered permanently disabled and incapable of even the most sedentary occupation. Under the applicable deferential standard of review, the court concluded that substantial evidence supported the insurer’s decision to terminate the employee’s long term disability benefits. It was not unreasonable for the insurer to reject the treating physician’s opinion in favor of the independent physician’s opinion in deciding to terminate the employee’s ERISA benefits.

If you need assistance navigating your claim for short term or long term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com.  We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee.  We offer a free consultation and would love to speak with you.