On March 10, 2015, Judge Rudolph Randa granted summary judgment in favor of an insured beneficiary, represented by Hawks Quindel, S.C., who sued Metropolitan Life Insurance Company (“Met Life”) and the S.C. Johnson Long Term Disability Insurance Plan (collectively, the “Defendants”) over the wrongful termination of her long-term disability benefits. See Karul v. S.C. Johnson & Son Long Term Disability Plan, No. 13-C-900, 2015 WL 1034150 (E.D. Wis. Mar. 10, 2015).
After several years of aggressively pursuing the insured’s benefits through the administrative appeals process and into federal court, Hawks Quindel was able to reinstate her benefits and further recover the following:
1. The full amount of the insured’s unpaid disability benefits from 2012 to the present, including the value of her associated medical insurance coverage benefits, in the amount of $130,878.12;
2. Prejudgment interest on the disability benefits stated above, calculated at the prime rate and compounded annually, totaling $8,703.93; and
3. Hawks Quindel’s attorneys fees, totaling $36,976.50.
The judgment was a major victory for long-term disability claimants, as insurance companies such Met Life typically enjoy the litigation advantage of “arbitrary and capricious review” in cases governed by ERISA. This is a standard of review that affords discretion to the defendants.
Despite the Defendants’ advantage in this case, the attorneys at Hawks Quindel were able to convince the Judge that their decision to terminate the claimant’s benefits was arbitrary and capricious. In arriving at his decision, the Judge found that:
• Met Life’s “independent medical examiner” stated that he disagreed with the work restrictions provided by the claimant’s treating physician, but failed to explain why;
• Met Life’s reviewing physician described the medical evidence provided by the claimant in a manner that stripped away the relevant adjectives demonstrating her disability;
• The claimant’s award of Social Security Disability Insurance (SSDI) benefits reinforced his conclusion that the claimant had submitted sufficient proof of her continuing disability to the Defendants.
The judgment will provide helpful case law to other long-term disability insurance claimants whose benefits are wrongfully denied.