Neuromusculoskeletal and Soft Tissue Exclusion

I have seen a number of MetLife long term disability policies that contain a neuromusculoskeletal and soft tissue exclusion.  The exclusion is not necessarily an exclusion per se, but rather, a limitation.  Most of the policies limit benefits to two years if the claimant is disabled due to a neuromusculoskeletal and soft tissue disorder unless there is “objective medical evidence of. . . . seropositive arthritis;  spinal tumors, malignancy, or vascular malformations; radiculopathies; myelopathies; traumatic spinal cord necrosis; or myopathies.  Perhaps this exclusion was intended to cover conditions such as fibromyalgia.  Regardless of the intent, the exclusion has the potential to exclude a number of serious conditions.  More troubling is the fact that it seems very unlikely that an individual purchasing a long term disability policy would have any idea whatsoever that he/she could be disabled, but still only receive two years of benefits.  Unfortunately, the jurisprudence appears to uphold this exclusion.  In one recent case, the plaintiff argued that the language was ambiguous.  The Court concluded that “MetLife’s interpretation of the Plan is reasonable.”  Brien v. Metropolitan Life Ins. Co., 2012 U.S.Dist. Lexis 135790 (Sept. 21, 2012).  The Plaintiff argued that because he was disabled due to a number of conditions, including conditions supported by objective medical evidence, the exclusion did not apply. The Court disagreed and upheld the denial of benefits.

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About tngadisabilitylawyer
Disability Lawyer in Tennessee and Georgia.

One Response to Neuromusculoskeletal and Soft Tissue Exclusion

  1. Pingback: Self-Reported Symptoms Limitation « Long Term Disability Lawyer

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