Court: United States District Court for the Middle District of Louisiana
Insurance Carrier: Metropolitan Life Insurance Company (MetLife)
Claimant’s Employer: HP, Inc.
Claimant’s Occupation: IT Administrator
[Note: This claim was not handled by the Ortiz Law Firm. The claim is being summarized here as being educational and informational on how Federal Courts review long term disability insurance claims.]
Jason Seneca, an IT administrator for HP, Inc., began receiving long-term disability benefits from MetLife in September 2018 after being diagnosed with rheumatoid arthritis and neuropathy. His job required extensive walking, bending, standing, and lifting, which made his condition a significant challenge. Seneca’s benefits were initially approved based on medical documentation from his primary care physician and a rheumatologist confirming his disabling conditions.
However, after two years, MetLife reevaluated his claim under a stricter definition of disability, requiring him to prove that he was unable to work in any occupation, not just his previous one. This review ultimately led to the termination of his benefits in September 2020.
Why MetLife Terminated Seneca’s Benefits
MetLife notified Seneca in January 2020 that he needed to provide updated medical records in order to continue receiving benefits beyond September 2020. Upon review, the insurance company found evidence that Seneca’s condition had purportedly improved:
- His diagnosis had changed from rheumatoid arthritis to psoriatic arthritis and neuropathy.
- By 2019, his medical records indicated that he had resumed some activities, such as playing guitar.
- His doctors noted that his psoriatic arthritis was in remission and that his neuropathy was stable with medication.
- His primary care physician did not place him on any work restrictions on him after September 2020.
- An independent physician, Dr. Mahdy Flores, reviewed the records and found insufficient evidence of a condition severe enough to warrant continued disability benefits.
Despite a July 2020 determination by the Social Security Administration (SSA) that Seneca was disabled, MetLife determined that the SSA’s findings were not binding on its own decision-making process.
Seneca’s Appeal and the Court’s Decision
Seneca appealed MetLife’s termination decision nearly a year and a half later, arguing that his condition was chronic, degenerative, and unlikely to improve. He submitted additional medical records, a 2020 evaluation from Dr. Kevin Callerame, and statements from friends and family attesting to his difficulties.
MetLife referred the appeal to another independent physician, Dr. Roger Belcourt, who also found no disabling impairment as of September 2020. However, in 2022, after reviewing additional medical records, Dr. Belcourt acknowledged that Seneca had some work restrictions beginning in July 2022—nearly two years after MetLife terminated benefits.
The court ruled in favor of MetLife, finding that its decision was supported by substantial medical evidence. The judge emphasized that:
- The majority of Seneca’s treating and reviewing physicians, including independent evaluators, found no severe restrictions at the time of termination.
- The SSA decision was not binding, and MetLife had acknowledged and considered it.
- The insurer did not abuse its discretion because its decision was based on a reasonable interpretation of the available medical records.
As a result, Seneca’s lawsuit was dismissed.
Facing a Long-Term Disability Denial? Get Legal Help.
If your long-term disability benefits have been denied or terminated—especially if an insurer claims your condition has improved despite your ongoing struggles—you don’t have to fight alone. Insurance companies often use selective medical reviews to justify cutting off benefits, even if your condition remains serious.
At the Ortiz Law Firm, we specialize in fighting wrongful termination of disability benefits under ERISA. Contact us online or call (888) 321-8131 today for a free case evaluation. We can help you get the benefits you deserve.
Here is a PDF copy of the decision: Seneca v. MetLife
