MetLife forced to make back payments, pay attorney fees, after denying North Carolina disability claim

A recent opinion by the Fourth District Court of Appeals illustrates the importance of being represented by a qualified North Carolina disability attorney when dealing with insurance companies in cases involving permanent disability.

In this case, a woman employed as a customer service representative for Cingular Wireless became disabled after suffering from trigger finger disorder, tendinitis and carpel tunnel syndrome. She had six operations to treat her medical issues and left work in April 2003 under short-term disability benefits from MetLife.

MetLife terminated her benefits after five weeks and she returned to work. She then began treatment for neck and back pain and left work again after a week on the job. MetLife reinstated her benefits after a doctor advised her to “avoid repetitive computer work and hand use.”

Her benefits lapsed that September after one of her doctors said she could return to work on a limited basis. She was unable to make it through her first day back on the job after experiencing severe pain. She was approved for long-term disability benefits in December 2003.

In August 2005, MetLife terminated those benefits, saying medical documents did not substantiate her claim of inability to perform her customary work duties. Two independent medical examiners concurred with MetLife’s opinion.

For the next two years, the employee submitted additional medical documentation without effect, before filing a lawsuit in the Eastern District of North Carolina. The court found on the employee’s behalf, saying MetLife had a conflict of interest in its dual role of both evaluating and paying for claims.

In other words, the insurance company responsible for paying benefits in legitimate North Carolina work injury cases, was also the one deciding whether the cases were legitimate! In such cases, the court essentially found that the insurance company must err on the side of the injured worker.

The court awarded her long-term disability benefits from 2003 forward, and ordered the insurance company to pay her more than $18,000 in attorney fees.

The insurance company appealed both decisions and the appeal was denied.

If you have been injured in a work accident or are dealing with a North Carolina disability claim, contact the Law Offices of Lee & Smith today for a free and confidential appointment to discuss your rights. Call 800-887-1965.

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