In 2012, an assistant news editor for Investor’s Business Daily suffered a heart attack resulting from an ongoing heart condition. He was forced to file a disability claim with MetLife, his employer’s chosen disability carrier. Although Mr. Popovich’s cardiologist had reported that Popovich could physically handle a job performed at the sedentary exertional level, he deemed him disabled due to cardiomyopathy resulting in dizziness, heaviness in chest and pain in his left shoulder blade. However, MetLife denied the claim based on a normal ejection fraction despite reports from the cardiologist that angiographic studies showed severe coronary artery disease. Another treating physician had reported that Mr. Popovich was experiencing chest discomfort while undertaking even mild activities.

After reviewing MetLife’s decision, the court sided with Mr. Popovich, finding his treating doctors’ reports more persuasive. Although in ERISA disability claims a court is not required to give a treating physician’s opinion more weight, the court did so in this case for several reasons.

First, the court was critical of MetLife’s consultant because he never examined the plaintiff. Additionally, the consultant’s report contained a number of factual errors. Also, as is the case with many disability claims based on cardiac conditions, the consultant focused solely on ejection fraction findings while ignoring other angiographic findings.

This is commonly seen in claims based on cardiac conditions. A carrier often places too much emphasis on ejection fraction findings despite other evidence supporting the claim for disability.

The social security administration has specific guidelines when dealing with claims based on cardiac conditions and it seems that MetLife’s consultant was following similar guidelines. However, it is important that a disability carrier properly consider all evidence rather than focusing on one test.

In this case, the court pointed out that MetLife failed to perform a proper vocational analysis and did not give appropriate consideration to the stress caused by Mr. Popovich’s occupation. MetLife had failed to consider the non-physical aspects of the job and improperly denied the claim in the process.

This case was not handled by our office, but we think it can be beneficial to those struggling to obtain long-term disability benefits. If you have any questions about your own disability claim, contact one of our attorneys at Dell & Schaefer for a free case evaluation.