Our client, let’s call him Michael, had disability insurance through MetLife. Michael was also diagnosed with Type 2 diabetes, glaucoma, congestive heart failure and high blood pressure, none of which alone usually prevent a person from working. His doctor provided a letter to MetLife listing Michael’s symptoms as shortness of breath, vision impairment and fatigue.
Michael, who was taking 14 medications each day — including eye drops, two different insulin shots and 30 pills – had accumulated 118 pages of information regarding the side effects of the medications, such as fatigue, dizziness, blurred vision, nervousness, chest pain, confusion and headaches.
The medications, however, were keeping Mr. Walker alive. Nevertheless, he had a relatively high level of functioning for decades, continuing to work despite his longstanding affliction, until he could work no more.
MetLife refused to consider the side-effects as a contributing factor to Michael’s disabling condition, even after he cogently argued that to return to work he would be forced “to curtail the current medication regimen and have the diabetes, glaucoma, congestive heart failure and high blood pressure controlled or cured without drugs. If anyone can figure a way to do this, I’ll be the first in line to try it.”
The district court found that, among other things, MetLife’s failure to consider the effects of the multiple medications Michael took on a daily basis to maintain even his current level of function suggested a biased claims investigation.
In its opinion, the court relied on federal case law from other states supporting the consideration of medications in determining disability. In Godfrey v. BellSouth Communications, 89 F.3d 755, 759 (11th Cir. 1996), the 11th U.S. Circuit Court of Appeals held that the insurer’s decision to deny benefits was arbitrary when it ignored the side effects of drowsiness caused by medication.
“It seems to the court that the only rational explanation for the failure of the defendant’s physicians to follow up on the evidence they did have and to ignore the effects of the medications that the plaintiff was taking is that they knew in fact that the plaintiff was disabled and following up leads and considering the effect of the medications would only confirm what any reasonable doctor would have already known,” wrote the court (emphasis in original).
The court also cited with approval Flanigan v. Liberty Life Assur. Co. Of Boston, 277 F.Supp.2d 840, 844 (S.D. Ohio 2003), which found that “[t]he fact that Plaintiff is on many strong medications is objective evidence that she is indeed chronically disabled,” and Conrad v. Reliance Standard Life Ins. Co., 292 F.Supp.2d 233, 241 (D. Mass. 2003), in which the court determined that the insurer denied the claimant a full and fair review by only inquiring into the claimant’s ability to sit, stand, walk, etc., without considering the effects of the claimant’s potent pain medications.