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FLORIDA RECORD

Thursday, March 28, 2024

Policyholder fights disability claim appeal, alleges breach of contract against Metropolitan Life Insurance Co.

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MIAMI — A man has filed a claim against Metropolitan Life Insurance Co. alleging the insurance company unfairly denied disability payments. 

Kevin Winter filed a complaint on Aug. 10 in the U.S. District Court for the Southern District of Florida, Miami Division, against Metropolitan Life Insurance Co., alleging that the insurance company knowingly violated the Employee Retirement Income Security Act.

According to the complaint, the plaintiff alleges that on July 2015, he was forced to discontinue working due to his disabling conditions, which, according to the claim, include suffering from gambling addiction, alcoholism, cocaine dependence, depression, anxiety, and a severe risk of relapse. He was allegedly employed by Morgan Stanley & Co. Inc. at the time he was a policy holder and he claims he was eligible for the long-term disability policy. The defendant allegedly issued a decision about the plaintiff's claim to short-term disability 336 days after the defendant allegedly initially began reviewing the plaintiff's claim. The plaintiff purportedly sent a letter to inform the defendant that the continued delay of benefits was allegedly harming his health and well-being by increasing his stress levels and interfering with his ability to focus on his health and treatment. 

The plaintiff holds Metropolitan Life Insurance Co. responsible because the defendant allegedly reviewed his file for 12 months, which he claims was an unnecessary and unwarranted delay tactic, failed to provide a full and fair review and failed to timely take action on the plaintiff’s long-term disability appeal.

The plaintiff requests a trial by jury and seeks judgment against the defendant, unpaid long-term disability benefits and interest, attorneys' fees, costs of litigation and other relief as the court deems appropriate. The plaintiff is represented by Edward Philip Dabdoub and Carter Meader of Wagar Dabdoub PA in Miami.

U.S. District Court for the Southern District of Florida, Miami Division, case number 1:16-cv-23441

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