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A recent federal court decision provides an important reminder that an insurance company’s decision to terminate long-term disability benefits is not necessarily the final word.
In Fitzgerald v. Metropolitan Life Insurance Company, No. 23-13169 (E.D. Mich. July 9, 2026), the United States District Court for the Eastern District of Michigan ruled in favor of a long-term disability claimant whose benefits had been terminated by Metropolitan Life Insurance Company (“MetLife”). The court granted the claimant’s motion to reverse the administrative denial of LTD benefits and denied MetLife’s motion to affirm its decision.
The decision illustrates two issues that frequently arise in long-term disability disputes: which policy provisions actually govern the claim and whether an insurer has fairly evaluated the medical evidence demonstrating the claimant’s functional limitations.
The Claimant Had Been Receiving LTD Benefits for Years
The plaintiff, Kirk Fitzgerald, worked for nearly ten years as a production machine operator for Nexteer Automotive. After developing serious health problems in 2015 that prevented him from continuing to work, he initially received short-term disability benefits and subsequently applied for long-term disability benefits administered by MetLife. His LTD claim was approved in 2016.
MetLife continued paying Fitzgerald LTD benefits until December 15, 2020, when it terminated his claim. Fitzgerald pursued an administrative appeal, but MetLife upheld its decision. He then filed suit in federal court under ERISA Section 502(a)(1)(B), seeking to recover benefits under the terms of the plan.
The Court Found MetLife Applied the Wrong Plan Provision
One of the most significant issues before the court concerned which version of the disability plan controlled Fitzgerald’s claim.
The administrative record contained different plan certificates. MetLife relied upon an earlier version when terminating Fitzgerald’s benefits. The court, however, determined that the later version applied based upon the date of Fitzgerald’s claim. Significantly, Fitzgerald had applied for LTD benefits in 2016, and MetLife originally approved his claim under the later plan provisions.
After reviewing the administrative record, the court concluded that Fitzgerald qualified for LTD benefits under the governing plan. Because that version of the plan imposed a 60-month maximum benefit period, the court limited Fitzgerald’s award to the months remaining within that period.
The decision is an important example of why the precise language of the LTD policy or plan cannot be overlooked. Disability claims often turn not simply on a diagnosis, but on the specific definition of “disability” contained in the governing plan and whether the insurance company applied that definition correctly.
Medical Evidence Must Be Evaluated in Context
The case is also noteworthy because Fitzgerald’s claim involved significant psychiatric conditions. A report discussing the decision states that Fitzgerald suffered from conditions including major depressive disorder, bipolar disorder, and generalized anxiety disorder, and that the court found he remained disabled as a result of his psychiatric conditions under the applicable plan definition.
The court’s decision demonstrates why an insurer’s medical review should not be viewed in isolation from the complete administrative record. In an LTD claim, the critical issue is generally not simply whether a claimant carries a particular diagnosis. The focus is whether the claimant’s medically supported symptoms and limitations prevent the claimant from satisfying the occupational requirements established by the governing disability plan.
Why This Decision Matters for LTD Claimants
Fitzgerald highlights several important lessons for individuals whose long-term disability benefits have been denied or terminated.
First, an insurer’s interpretation of the policy is subject to challenge. Before accepting an insurance company’s determination, it is important to identify the actual plan documents governing the claim and closely analyze the applicable definition of disability.
Second, an administrative appeal is extremely important. Fitzgerald pursued his administrative remedies before bringing his ERISA action in federal court. The evidence developed during the claim and appeal process can become critically important if litigation ultimately becomes necessary.
Finally, a termination of benefits does not necessarily mean that the claimant is no longer disabled. An insurance company may conclude that the medical information does not satisfy the policy, but that conclusion can be challenged. In Fitzgerald, the federal court independently examined the administrative record and determined that the claimant qualified for LTD benefits under the controlling plan.
Challenging the Denial or Termination of Long-Term Disability Benefits
Long-term disability claims can involve complicated medical, vocational, contractual, and ERISA issues. When benefits are denied or terminated, the insurer’s reasoning, the medical reviews it relied upon, the applicable occupational standard, and the precise language of the disability policy should all be carefully examined.
The Fitzgerald decision serves as an important reminder that insurance companies can get disability determinations wrong, and federal courts can reverse those decisions when the evidence and governing plan support the claimant’s entitlement to benefits.
If your long-term disability insurance claim has been denied or your previously approved benefits have been terminated, an experienced disability insurance attorney can review the decision, evaluate the administrative record, and determine the appropriate steps for challenging the insurer’s determination.
This article is provided for informational purposes only and does not constitute legal advice. Every disability insurance claim depends upon the specific policy language, medical evidence, occupational requirements, and circumstances of the individual claim.
Contact the Law Office of Justin C. Frankel, P.C. today for a free consultation (516) 222-1600 and learn how an experienced ERISA disability attorney can help protect your rights and maximize your chances of success.
Justin C. Frankel is the founder of the Law Office of Justin C. Frankel, PC, a Long Island, New York headquartered law firm representing clients nationwide in disability insurance claims. For more information please go to our website www.jfrankellaw.com.
The post Federal Court Rules Against MetLife and Awards Long-Term Disability Benefits to Claimant first appeared on Law Office of Justin Frankel written by Justin C. Frankel .
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📰 This article is sourced from a trusted insurance industry publication. Legacy Life Insurance Group shares this for informational purposes only. Always consult a licensed advisor for personalized guidance.