In Jahn-Derian v. Metropolitan Life Insurance Co., a California Federal Judge disagreed with MetLife’s decision to deny disability benefits due to a lack of objective evidence. First, the court noted that objective evidence is not required since for many medical conditions, such as fibromyalgia, chronic migraines or mental disorders, no objective evidence is medically available. Second, Jahn-Derian provided significant objective evidence to support her claim.

The court did not remand on this issue, but found that, “In sum, the evidence establishes that plaintiff, more likely than not, was disabled within the meaning of the Plan’s terms.” The court ordered MetLife to pay the claimant 24 months of disability based on her inability to perform the tasks of her own occupation. This is a great opinion for disability claimants nationwide.

Objective Evidence is Not Required to Support a Disability Claim

After being employed for 13 years by Kaiser, Pamela Jahn-Derian was Director of Risk Management when she stopped working due to severe back pain with numbness and stiffness in her arms. She was diagnosed with “severe degenerative disc disease and nerve impingement at C5-6 and C6-7 of her spine.” She underwent spine surgery and several other procedures in an attempt to relieve her pain, but ultimately took large amounts of pain killers that interfered with her cognitive skills.

Jahn-Derian applied for long term disability benefits with her insurer, MetLife. The policy terms required Jahn-Derian to be unable to work for 24 months in her own occupation. MetLife denied her claim on the grounds that she did not provide objective evidence of her disability. When she exhausted her administrative remedies, she filed this lawsuit.

MetLife argued that the terms of its policy required a beneficiary to provide “written evidence satisfactory” to the administrator that the person is disabled. MetLife interpreted this to mean objective evidence. The court disagreed with MetLife and noted that nothing in the plan language “requires a beneficiary to prove she is ‘totally disabled’ solely by objective evidence.” The court relied on precedent to conclude that the phrase “satisfactory proof” is interpreted to mean “‘proof that would be satisfactory to a reasonable person that you have become disabled.'”

If objective proof was the standard, those with conditions like fibromyalgia, chronic migraines and chronic fatigue syndrome would never qualify for disability. Even though not required to prove her claim, in this case, Jahn-Derian submitted sufficient objective proof to prove she was disabled from working in her own occupation.

Even Though Not Required, Claimant Presented Sufficient Objective Evidence of Her Disability

In this case, MetLife relied on opinions of reviewing physicians who never examined Jahn-Derian. It ignored evidence such as:

· Detailed medical reports and letters from her treating physician, Dr. Williams, a neurosurgeon who performed surgery on claimant and continued to treat her for her disabling pain.

· Medical records from other treating physicians that supported Dr. Williams’ opinion.

· Letters from friends and coworkers regarding her severe pain and inability to work.

The court concluded, “There is substantial objective and reliable medical evidence in the medical record to support the severity of plaintiff’s disabling pain allegations… Plaintiff shall be granted disability benefits during the ‘own-occupation’ period of disability.” It remanded to MetLife to evaluate whether or not she was disabled from working in “any occupation.”

This case was not handled by our office, but we think it is instructive for those whose insurers demand objective evidence of a disability and what types of evidence are considered objective. If you have a question or need help with your disability claim, call one of our attorneys for a free consultation.