George Bailey Wins & Metlife Pays
When George Bailey – fictitious name but my very real client – was doing his job as a Shear Operator, cutting metal sheets, plates, or bars and lifting them from one spot to another to keep our aging railroads working, he began experiencing dizziness, heart palpitations and chest pain.
Eventually, George was forced to stop working for his employer, Progress Rail Services and filed a claim under his employer-sponsored disability policy with MetLife.
MetLife, like most disability insurance companies, uses the DOT or The Dictionary of Occupational Titles to describe various occupation standards including a Shear Operator. The DOT classifies a Shear Operator as a heavy physical demand job including the ability to lift 50-100 pounds.
After George’s medical tests revealed cardiomyopathy, reduced heart function of 20-25% (EF) and global hyperkinesis among other serious cardiac conditions, his cardiologist restricted his lift range from 15-40 pounds and for over a year, MetLife agreed and paid George’s disability benefits.
However, after the first year, George’s doctor updated his Attending Physician Statement (APS), increasing George’s maximum lifting range to 50-pounds and stating George could return to his regular job. Ah-ha! MetLife took notice.
MetLife suddenly switched George’s occupation from a heavy physical demand job (lifting 50-100 pounds) – consistent with the DOT definition of a Shear Operator – to a medium demand and advised George to get back to his ‘regular job’ although restricting him to a 50-pound lifting maximum.
Why Would George’s Own Cardiologist Write A Report To Metlife That Didn’t Include All Of The Lifting Requirements Of George’s Job?
Answer: George’s cardiologist didn’t know because he is a doctor, not a disability insurance claims adjuster.
When we provided George’s cardiologist with a copy of George’s job description consistent with the DOT classification that required he lift from 50-100 pounds, George’s cardiologist resubmitted his report (or APS), advising that George could not perform his regular job duties with a lifting capacity of 50-pounds.
We presented the cardiologist clarification to MetLife, the DOT classification, and our client’s job description and guess what? MetLife reinstated George Bailey’s benefits. CASE CLOSED!
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