Facts

Nazir Hamid was a loan officer at Bank of America and a participant in his employer's employee welfare benefit plan. Metropolitan Life Insurance Company (MetLife) was the claims administrator for the short-term disability (STD) and long-term disability coverage offered under the plan. Based on complaints of chronic face and neck pain and headaches, Hamid submitted claims for STD and LTD benefits under the plan. MetLife determined that Hamid was not disabled under the terms of the plan and denied his claims.

Hamid sued for his benefits and the parties filed cross-motions for judgment.

PLAINTIFF'S CONTENTIONS: Plaintiff contended that MetLife erroneously denied his STD and LTD claims. Plaintiff further contended that the denial was improperly conditioned on objective evidence while disregarding his subjective complaints of pain. Plaintiff argued that the lengthy medical record was also misconstrued as it contained plenty of evidence of chronic pain that interrupted his ability to work. Ultimately, plaintiff contended that the evidence in the administrative record demonstrated that he was disabled under the terms of the plan and he was therefore entitled to summary judgment.

DEFENDANTS' CONTENTIONS: Defendants MetLife and the plan contended that plaintiff failed to satisfy his burden of proving he was disabled under the terms of the plan. MetLife arranged for six independent physician consultants of various specialties to review the file, and each of those experts opined that plaintiff's reported restrictions and limitations from performing his occupational duties were not medically supported. Defendants noted that plaintiff's own otolaryngologist described plaintiff's reported symptoms as far out of proportion to his examination findings and imaging results. Based on the opinions of the independent physician consultants, Defendants determined that plaintiff was not disabled under the plan and therefore not entitled to STD and LTD benefits.

Result

The court granted plaintiff's motion for summary judgment and denied defendant's motion.