In Tommy Dowdy and Sharon Morris-Dowdy v. Metropolitan Life Insurance Company, the U.S. Court of Appeals for the Ninth Circuit held that Tommy Dowdy and his wife were entitled to receive accidental dismemberment benefits under Mrs. Dowdy’s MetLife disability policy she had through her work at Bank of the West. The appellate court remanded the case to the district court for a determination of “the amount of benefits owed.”

It all started in September 2014 when Tommy Dowdy was in a car accident. His left leg was severely injured, almost severing it at the ankle. Attempts to save his leg were unsuccessful due to a wound infection that would not heal. Finally, five months after the accident, the leg was amputated just below the knee.
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In 2012, an assistant news editor for Investor’s Business Daily suffered a heart attack resulting from an ongoing heart condition. He was forced to file a disability claim with MetLife, his employer’s chosen disability carrier. Although Mr. Popovich’s cardiologist had reported that Popovich could physically handle a job performed at the sedentary exertional level, he deemed him disabled due to cardiomyopathy resulting in dizziness, heaviness in chest and pain in his left shoulder blade. However, MetLife denied the claim based on a normal ejection fraction despite reports from the cardiologist that angiographic studies showed severe coronary artery disease. Another treating physician had reported that Mr. Popovich was experiencing chest discomfort while undertaking even mild activities.
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In Bosley v. Metropolitan Life Insurance Company (MetLife), Robert Bosley, a nurse at Kaiser Permanente, had his claim for long-term disability benefits granted in 2009 based on the diagnosis of chronic fatigue syndrome. Subsequently, he returned to work in a position that caused him less stress. That lasted until 2011 when MetLife again granted him long-term disability benefits based on his “laundry list of health problems.”
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Dowdy v. Metropolitan Life Insurance Company (MetLife) is a sad case for plaintiffs who have a pre-existing condition that contributes to their otherwise qualifying event for collecting insurance benefits. Thomas Dowdy and his wife had purchased an accidental death and dismemberment policy through Mrs. Dowdy’s employment at Bank of the West.
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In Leonard v. MetLife Insurance Company, the Ninth Circuit court of appeals upheld the California district court’s dismissal of plaintiff’s ERISA lawsuit against MetLife when she failed to exhaust her administrative remedies or prove there was any applicable exception to excuse her from filing an administrative appeal. The court did not discuss her case or consider the merits of her disability claim, but focused on the proper procedure claimants must file when seeking disability benefits.
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