The ERISA case is styled, Susan Hennen v. Metropolitan Life Insurance Company. The case does illustrate how to win an ERISA case.
Hennen had received short term disability (STD) benefits for two years as the result of a back injury. Hennen then applied for long term disability (LTD) benefits. The disability plan that Hennen had contained a two year limit for neuromusculoskeletal disorder, subject to exceptions, including one for radiculopathy, a “Desease of the peripheral nerve roots supported by objective clinical findings of nerve pathology.” After Metlife terminated Hennen’s benefits, she sued under ERISA, arguing that Metlife’s determination that she did not have radiculopathy was arbitrary and capricious. The court hearing the case had granted summary judgment in favor or Metlife. This appeals court reversed the ruling saying Metlife acted arbitrarily when it discounted the opinions of four doctors who diagnosed Hennen with radiculopathy in favor of one physician who ultimately disagreed, but only while recommending additional testing that Metlife declined to pursue.