ERISA-Seventh Circuit Vacates Decision Of District Court Stopping Disability Benefits After Two Years

In Hennen v. Metropolitan Life insurance Company, No. 17-3080 (7th Cir. 2018), plaintiff-appellant Susan Hennen worked as a sales specialist for NCR Corporation from 2010 to May 2012, when she sought treatment for a back injury.  As an employee, Hennen was covered by long-term disability insurance under a group policy provided by defendant-appellee Metropolitan Life Insurance Company (“MetLife”).  When physical therapy and surgery failed to resolve her injury, Hennen applied for long-term disability benefits under the insurance plan.

Acting as plan administrator, MetLife agreed that Hennen was disabled and paid benefits for two years.  The plan has a two-year limit, however, for neuromusculoskeletal disorders.  That limit is subject to several exceptions, one of which applies to cases of radiculopathy.  After paying for two years, MetLife terminated Hennen’s benefits, finding that the two-year limit applied.  Hennen believes that she is entitled to continued benefits because she has radiculopathy. She sued under ERISA, arguing that MetLife’s determination that she did not have radiculopathy was arbitrary and capricious.  The district court granted summary judgment for MetLife, and Hennen appeals.

The Circuit Court of Appeals for the Seventh Circuit (the “Court”) reversed the district court’s decision and remanded the case back to the district court. The Court said that MetLife acted arbitrarily when it discounted the opinions of four doctors who diagnosed Hennen with radiculopathy in favor of the opinion of one physician who ultimately disagreed, but only while recommending additional testing that MetLife declined to pursue.

 

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