Kaiser, MetLife Won’t Honor Woman’s Disability Claims
LOS ANGELES (CN) - Metropolitan Life Insurance Company wrongfully denied a woman benefits under Kaiser Permanente Group’s Long Term Disability (LTD) Insurance Plan, she alleges in a complaint filed in the U.S. District Court Central District of California.
Pamela Jahn-Derian was employed by Kaiser Foundation Healthplan Inc. and was covered by the LTD plan when she became disabled. Jahn-Derian made a claim to MetLife for LTD benefits following her last day of work on Sept. 19, 2011.
In August 2012, however, Metlife informed her she did not qualify for benefits under the LTD plan because “in MetLife’s opinion, plaintiff had not provided sufficient evidence of her disability,” according to the complaint.
Jahn-Derian appealed the decision, providing “overwhelming evidence of a covered LTD claim,” but MetLife upheld its denial.
She says her doctors never received requests from MetLife for medical information, so she provided the pertinent information, but was once again denied benefits. Jahn-Derian claims MetLife knew she was entitled to benefits, failed to provide prompt explanation for her denial of benefits, and failed to adequately explain what materials were needed to make a decision.
She claims the company also “concealed and withheld from plaintiff the notice requirements MetLife and the LTD Plan were required to provide plaintiff pursuant to ERISA (Employee Retirement Income Security Act) … and failed to properly and adequately investigate the merits of plaintiff’s disability claim, and to provide a full and fair review of plaintiff’s claim,” according to the complaint.
Jahn-Derian says she wants a court to order MetLife to pay her the benefits it owes her.
Alan Kassan and Brent Dorian Brehm of Kantor & Kantor, in Northridge, represent the plaintiff.