Mixon v. Met Life
Ms. Mixon, a long term lupus sufferer, submitted a claim for disability benefits to Met Life. Met Life turned to one of its tame, file review physicians, who had no choice but to agree that Ms. Mixon was disabled. However, gazing into his crystal ball, the Met Life doctor predicted that Ms. Mixon would "get better" before any benefits were due. So Met Life denied the claim.
Ms. Mixon appealed. Her treating physician noted that it was now months later and, contrary to Met Life’s prediction, Ms. Mixon had not gotten any better.
So now Met Life was stuck, because it had already agreed that Ms. Mixon’s condition was severe enough to disable her, and it didn’t have any evidence that she had gotten better. But Met Life still managed to deny Ms. Mixon’s claim. This time Met Life contended that Ms. Mixon hadn’t submitted her claim until after she was no longer working, so her disability wasn’t covered. Of course, given that virtually everyone waits until after they are disabled to submit a disability claim, with this reasoning Met Life will never have to pay anyone.
The good news is that Met Life was forced to defend this nonsense in Court. Judge Selna looked at the facts and ruled that Met Life had abused its discretion in denying Ms. Mixon’s claim.