Hennen v. MetLife

DeBofsky Sherman Casciari Reynolds P.C., recently won a remand from the U.S. Court of Appeals for the Seventh Circuit in Hennen v. Metro. Life Ins. Co., 904 F.3d 532 (7th Circ. 2018). Susan Hennen suffered from chronic low back pain radiating into her legs, despite having undergone three back surgeries. She applied for benefits under a group policy of disability insurance issued by MetLife to her employer. MetLife approved Hennen’s disability claim, but only for two years, asserting that Hennen’s claim was subject to a 24-month limitation on benefits for “neuromusculoskeletal and soft tissue disorders.” Hennen challenged that decision, submitting her doctors’ findings, along with electromyogram (“EMG”) evidence that she suffered from “radiculopathies,” which is an exception to the 24-month limitation. MetLife nevertheless affirmed its decision to deny benefits, stating that Hennen had failed to submit “objective” evidence of nerve root pathology, as required under the policy.

MetLife based its decision on the report of a non-examining doctor, Neil McPhee, MD, who opined that Hennen’s EMG was negative for “active” radiculopathy. Yet even Dr. McPhee acknowledged that Hennen should undergo an independent medical exam with repeat EMG testing to more fully evaluate whether she suffered from radiculopathy. MetLife ignored that suggestion and instead affirmed its decision to deny Hennen’s benefits. Hennen filed suit, and the district court ruled in favor of MetLife, determining that MetLife’s decision was not arbitrary and capricious. The U.S. Court of Appeals for the Seventh Circuit reversed, however, finding it was unreasonable and thus arbitrary and capricious for MetLife to ignore the opinions of four doctors who all agreed Hennen suffered from radiculopathy, in favor of the opinion of one doctor, Dr. McPhee, who disagreed, particularly where Dr. McPhee had recommended further testing that MetLife declined to pursue. Rather than award benefits outright, the Seventh Circuit remanded the case to MetLife for further proceedings.