MetLife Subjective Condition Exclusion

In Warden v. Metropolitan Life Ins. Co., 574 F.Supp.2d 838 (Tenn.M.D. August 26, 2008), the Court evaluated a denial of benefits by MetLife based upon a subjective condition two year limitation.  Under the policy,

Monthly benefits are limited to 24 months during your lifetime if you are Disabled due to a:. . . .

2. Neuromusculoskeletal and soft tissue disorder including, but not limited to, any disease or disorder to the spine or extremities and their surrounding soft tissue; including sprains and strains of joints and adjacent muscles, unless the Disability has objective evidence of

a. seropositive arthritis;

b. Spinal tumors, malignancy, or vascular malformations;

c. radiculopathies;

d. myelopathies;

e. traumatic spinal cord necrosis; or

f. musculopathies.

In essence, MetLife denied the claim on the basis that the Plaintiff did not have objective evidence of radiculopathies.  In great detail, the Court reviewed the medical evidence and concluded that MetLife arbitrarily afforded greater weight to its consultant’s opinion who never examined the plaintiff.  The Court further concluded that the Plaintiff was entitled to LTD benefits under the Plan because the medical evidence revealed post surgical nerve diseases.  And finally, the Court ruled that MetLife’s conduct was culpable such that prejudgment interest and attorney fees were appropriate.