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Court rules heart surgery patient cannot dispute insurer's decision he is not disabled

Thomas Judge, a high school graduate, worked as a baggage handler for Delta for 20 years.  He underwent surgery to repair his aortic valve after his ascending aorta developed an aneurysm (most likely he suffered from a congenital bicuspid valve).  He filed for disability pay from Delta's disability insurer, MetLife, and filed supporting affidavits from four doctors. He was limited to lifting no more than 15 pounds.  Nevetheless, MetLife deemed Judge ineligible for disability benefits because there are other jobs in the economy from which he is not disabled.

The Sixth Circuit Court upheld the insurer's decision, even though, according to one of the judges on the panel, "MetLife twice applied the incorrect disability standard, relied on outdated medical records, discredited the conclusions of [his] treating physicians without conducting an independent medical evaluation, and operated under a conflict of interest [it would be paying the money out of its own coffers--not merely serving as the administrator of Delta's disability plan]."

As the dissenting judge pointed out, MetLife had to take a second shot at the determination after it applied the wrong disability standard in its first denial.  It then applied what the majority judges called "shorthand jargon" to deny Judge benefits, coincidentally applying  "jargon" that defined the exact same standard that it admits was incorrectly applied to Judge's initial disability determination.  As the dissenter noted, to write this second defective determination language off as mere "jargon" defies common sense. 

Judge Moore, the dissenter, pointed out that Met LIfe made a mistake and administered the disability plan in a manner which the Court usually rejects as "arbitary and capricious."  The judge pointed to prior cases where the explicit standard upheld by the majority was repudiated by the Court.  That, however, was apparently before insurers and special interests held sway over our judiciary.

The dissenting judge also marveled at the court's criticism of the brevity of disability insurance forms signed by some treaters--even though the forms were circulated by the insurer and not by Judge, the claimant.  Perhaps most disturbing to the dissenting Judge, however, was the court's and the insurer's parroting of medical records suggesting that Judge was "actually doing well" four weeks after surgery--and before he had even completed therapy from open heart surgery or returned to work--to justify denying his disability claim.

As the dissenting judge pointed out, in this case the federal court has simply "rubber-stamped" a patently wrong disability determination made by a plan administrator that is protecting its own purse.

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