In Bosley v. Metropolitan Life Insurance Company (MetLife), Robert Bosley, a nurse at Kaiser Permanente, had his claim for long-term disability benefits granted in 2009 based on the diagnosis of chronic fatigue syndrome. Subsequently, he returned to work in a position that caused him less stress. That lasted until 2011 when MetLife again granted him long-term disability benefits based on his “laundry list of health problems.”

Bosley briefly returned to work in March 2013, only to file a new claim for long-term disability benefits based in January 2014. He again suffered from chronic fatigue syndrome and fibromyalgia. This time, MetLife denied his claim. After exhausting his administrative remedies, Bosley filed an ERISA lawsuit.

After several different proceedings in the district court, the judge conducted a bench trial in which he considered the entire administrative file, including the ones from 2009 and 2011. The Court found Bosley was unable to work in his own occupation and therefore entitled to 24 months of long-term disability benefits. He did not prove he was disabled from any occupation as defined by his MetLife policy.

MetLife Erred by Requiring “Objective Proof” When No “Dipstick” Test Exists to Prove Chronic Fatigue Syndrome

Courts recognize that there “is no blood test or other objective laboratory test for chronic fatigue syndrome.” Instead, the person’s symptoms are compared to a “detailed Center for Disease Control list of symptoms” and then ruling out any other possible disorder. It “is a diagnosis of exclusion.” Insurers cannot deny benefits just because there is a “mere absence of ‘objective physical findings.”

Bosley’s physical symptoms were consistent. Two coworkers corroborated his reporting of symptoms by their own observations. Two treating physicians verified he suffered from the syndrome, not by conclusory statements, by describing his symptoms, including how much time he spent in bed every day. This was enough to tip the scales in favor of Bosley’s claim.

Reports by Bosley’s Treating Physicians Were More Credible than Findings by MetLife’s Reviewing Physicians

Three different physicians were hired by MetLife to review Bosley’s medical records. None of them examined Bosley or even spoke to him. One physician concluded that Bosley was not disabled since there was no objective findings in the record to support his subjective symptoms. As discussed, that is not a valid reason to deny benefits.

A second physician was a psychiatrist and the third, an infectious disease specialist. Since chronic fatigue syndrome is neither a psychiatric disorder or an infectious disease, the Court discounted their opinions. Instead, it gave more credence to Bosley’s two treating physicians, the only ones who had actually examined him and spoken with him, and who both verified his condition prevented him from working in his stressful job as an advice nurse.

Court Concludes Bosley is Disabled from Working in His Own Occupation

The Court concluded that all the evidence “weights in Bosley’s favor.” The treating physicians had clearly indicated that Bosley could not work in the stressful position of advice nurse. Neither opined as to whether or not he would be disabled from working in a different occupation after the definition of disability changed. Therefore, he was “entitled to payment of long-term disability benefits only under the ‘own occupation’ provisions” of his MetLife policy.

This case was not handled by our office, but may be instructive to those who have been diagnosed with a disease or condition for which there is no objective laboratory test that can be used to confirm the diagnosis. If you have questions about this case, or any other aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.