Wanda Glenn, 55, of Columbus, Ohio, has heart disease, and after 14 years as a sales manager for Sears she began a leave of absence in 2000. Immediately, she began receiving disability benefits from MetLife, Sears’ insurer. But in 2002 MetLife said Glenn no longer qualified for continued benefits and should go back to work. “I felt abandoned, after all those years paying into the plan,” Glenn says.
She sued, and the trial court in the case rejected her complaint. But on June 19, the U.S. Supreme Court ruled that Glenn had been the victim of a conflict of interest and ordered MetLife to pay her past benefits—roughly $1,000 a month going back some six years.
The situation Glenn faced is not unusual, one that occurs when the health plan administrator and the insurance company are one and the same. Sears contracted with MetLife to provide life, health and disability insurance for workers. MetLife also administered the insurance plans and so was called on to mediate conflicts between itself as the insurer and the employee.
The Supreme Court decided that lower courts should bear in mind the conflict of interest when the plan administrator serves dual roles. “The court did rebalance the field, giving claimants a better chance than they previously had to challenge an adverse claim determination,” said Jay E. Sushelsky, a senior attorney for the AARP Foundation, which filed a friend of the court brief in the case.
MetLife argued that Congress did not intend for courts to review the procedural structure, but rather wanted the employee plans to be as easy as possible for employers to administer. Officials for the company did not return repeated requests for comment.
The decision, Sushelsky said, is important to AARP’s members since nearly half are still employed. They or their dependents could face denials of benefits from health, life and disability insurers through their employers’ insurers, he said.
Glenn faced long odds in taking her case to the Supreme Court. Court officials said that 9,602 cases were filed during the past session. The court issued 74 decisions, including hers. Glenn says she’s thrilled with the outcome of her case. “If this can help anyone, I am so happy.”
What it means to you: If you think a claim for insurance benefits has been handled unfairly, first contact the phone number on your Explanation of Benefits form and ask to speak to a supervisor. If you are not satisfied, consider filing a legal claim under the Employee Retirement Income Security Act of 1974 (ERISA). To find a lawyer, contact a local city or county bar association.
Emily Sachar is a journalist and author based in Brooklyn, N.Y.