Opinion ID: 1359690
Heading Depth: 1
Heading Rank: 7

Heading: LTD Benefits for Dercum's

Text: In appealing MetLife's termination of her LTD benefits in 2004, Hobson enclosed an updated report from Dr. Sessoms, which explained that Hobson had some difficulty standing, walking, and sitting. Hobson also included a report from Dr. Paul Subrt, a dermatologist, who diagnosed her with Dercum's, which is a rare, chronic condition whose symptoms include painful adipose tissue, extreme weakness and fatigability, chronic generalized pain, fibromyalgia, epilepsy, cognitive dysfunction and depression, has no effective treatment, and can lead to lifelong debilitating disabilities. MetLife had two independent consultants review Hobson's file, both of whom concluded that none of Hobson's alleged impairments rendered her unable to work. The first, an internist, explained that the Dercum's diagnosis was not well-documented or supported, and that Hobson had not been given a treatment plan. The second, a neurologist and psychiatrist, concluded that although Hobson had a number of chronic medical problems which are severe, she appeared to be functional and was able to work without any difficulty at her sedentary job. In March 2005, MetLife upheld its denial of Hobson's claim for LTD benefits. MetLife granted Hobson's request for additional, discretionary review of the claim denial and referred her file to two more independent physicians. The first, a psychiatrist, explained that [t]here [we]re no complete psychiatric evaluations in the documentation or any complete mental status examinations. This consultant also determined that Hobson herself had submitted numerous letters [to MetLife which we]re ... very well written and contain[ed] no hints of any cognitive impairment. The second consultant, a dermatologist, opined that the Dercum's diagnosis actually was made by Ms. Hobson, not by her doctor, and found that she made it according to information ... on the Internet. Dr. Subrt, the physician who authored the brief, one-paragraph letter diagnosing Hobson with Dercum's, told MetLife's consultant that he d[id] not feel that Ms. Hobson [wa]s disabled and d[id not] understand why she c[ould] not do her job, which is sedentary. The second consultant also concluded that, aside from Hobson's subjective reports of pain, no objective finding confirmed that she was unable to work. On May 5, 2005, MetLife informed Hobson that it upheld its denial of her benefits claim and would not consider any further appeals, because Hobson had exhausted [her] administrative remedies under the [P]lan. Hobson then submitted two letters to supplement her claim. The first, authored by Dr. Subrt, explained that although he did not discern any dermatologic disability, he was not qualified to opine on whether she otherwise suffered disabilities. The second, a letter from her treating psychologist, stated that Hobson's depression had since worsened to the point of severe despondent episodes of sufficient severity that [she wa]s unable to function consistently enough to sustain employment. In letters dated May 11 and 19, 2005, MetLife informed Hobson that her additional submissions had not persuaded it to reconsider the denial of her benefits claim.