Insurance Co. Wrongly Denied Disability Claim, Woman Says
SAN FRANCISCO (CN) - Despite wrist problems that made it impossible to type all day, Lyme disease, excessive sweating, two bad ankles and more, Metropolitan Life Insurance Company denied a computer programmer’s disability claim, she says in a lawsuit filed in the U.S. District Court, Northern District of California.
Mirella Harrison, a Computer Systems Analyst for Kaiser Permanente, sued both Metropolitan Life Insurance Company (MetLife) and Kaiser Foundation Health Plan for breach of fiduciary duty.
Harrison alleges MetLife uses a definition of “total disability” that “is contrary to governing California insurance law,” and that its decision “was biased and tainted by MetLife’s financial conflict of interest, since it acted as plan administrator and plan funder.”
In May 2012, Harrison says she filed a disability claim with MetLife for chronic wrist pain and joint inflammation, chronic pain, irritable bowel syndrome, a recurring stomach infection, repeated chronic ankle injuries, and Lyme disease, and that several doctors had “restricted plaintiff from performing extensive keyboarding, the most important job duty in her occupation as a computer programmer.”
However, MetLife “ignored the medical evidence in the file supporting multiple, overlapping and co-morbid conditions, but instead purported to analyze whether she could perform a ‘sedentary’ occupation. MetLife never addressed the fact that no physician has said that plaintiff can keyboard without crippling pain for more than a few minutes, much less for a whole working day. MetLife failed to acknowledge the necessity for plaintiff to work in a capacity behind the scenes and in the computer field due to her primary hyperhydrosis which results in excessive sweating, limiting her ability to interact with the public. MetLife ignored the presence of Lyme, ignored the complaints of devastating fatigue and failed to address her consistent and well-documented troubles with chronic pain syndromes,” the complaint states.
When MetLife denied Harrison’s claim in Dec. 2012, she requested a copy of her claim file, but some documents were omitted, according to the complaint.
Harrison says she appealed the denial in July 2013, but MetLife upheld the denial in November 2013.
According to the complaint, the denial was based on statements by a consultant, Dr. Joseph Rea. Harrison says Rea talked to her ankle doctor, and consequently rendered an opinion about her wrists. Rea concluded that Harrison could use a keyboard and mouse all day if she wore wrist splints, the complaint states, although “the evidence in the file was unequivocal that wrist splints, while helping to alleviate flares when performing the most basic tasks, did not come close to permitting even occasional keyboarding or repetitive use of the hands.”
Harrison also alleges Rea reviewed two sets of medical records on the subject of Lyme disease and “opined that it was ‘not clear’ whether Lyme disease ‘was culpable or not in this situation,’” although the doctor who diagnosed Lyme disease had more complete lab results at her disposal than the doctor who did not diagnose Lyme disease.
“Rather than consider the multiple clinical findings supportive of and stemming from Lyme . . . Dr. Rea simply ignored them,” the complaint states.
Plaintiff seeks attorney’s fees and costs, an order that defendants pay benefits plus accrued interest, retroactive restitution plus accrued interest, an order to reinstate her benefits, an injunction prohibiting defendants from any future termination of her benefits, an order removing MetLife as fiduciary and barring it from further responsibility for claims determination, and prejudgment interest.
She is represented by Rebecca Grey of San Francisco.