Shalom v. Met Life

Ms. Shalom had worked as a bookkeeper for American Express, for many years. She was also a very sick woman, who suffered from a number of serious health conditions, including cancer, deep vein thrombosis, paralyzed vocal cords and a back injury which was causing nerve impingement. She worked for years in spite of her injuries, even though at least one of her doctors advised her to go on disability.

Finally, it got so bad that Ms. Shalom could no longer work, and she turned to Metropolitan Life Insurance Company (you know, the one with the happy Snoopy mascot). Met Life denied her claim, relying on the opinion of a nurse to overrule the opinions of Ms. Shalom’s treating physicians. When Ms. Shalom appealed, Met Life got a physician–Dr. Menotti–to review her file and–surprise–he agreed she was disabled. So Met Life had to pay.

But after a few months Met Life decided it needed to "re-evaluate" Ms. Shalom’s claim, even though it had no evidence her condition had changed. Dr. Menotti had apparently fallen off the face of the earth, because Met Life didn’t go back to him for a revised opinion. Instead Met Life found a new physician, whose full time job appeared to be performing file reviews for insurance companies. This new physician, working with basically the same medical records as Dr. Menotti, was able to opine that Ms. Shalom should go back to work.

When we got to trial Judge Real did not agree. He gave Judgment to Ms. Shalom.