`Superior Court - Suffolk
`Docket Number
`
`SUFFOLK,SS
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`COMMONWEALTH OF MASSACHUSETTS
`SUPERIOR COURT
`NO.
`
`)
`)
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`) )
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`)
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`
`JANET BRENNAN
`
`kg
`
`Plaintiff,
`
`v.
`
`METROPOLITAN LIFE INSURANCE
`COMPANY
`INSURANCESPECIALISTS, INC.
`Defendants
`
`COMPLAINT FOR DAMAGES WITH JURY DEMAND
`
`Plaintiff Janet Brennan brings this complaint against defendant Metropolitan Life
`
`Insurance Companyand defendant Insurance Specialists, Inc., for unlawfully refusing to
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`pay disability-insurance benefits undera disability insurance policy and certificate of
`
`insurance. This is not an ERISA governed lawsuit.
`
`PARTIES
`
`1.
`
`Plaintiff Janet Brennan (“Ms. Brennan”) is an individual and citizen of
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`Newton, Middlesex County, Massachusetts.
`
`2.
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`Defendant Metropolitan Life Insurance Company (“MetLife”) is an
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`insurance company existing under the laws of the State of New York, having a place of
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`business at New York, New York County, New York, and doing businessin the
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`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`Commonwealth of Massachusetts with an office at Boston, Suffolk County,
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`Massachusetts
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`3.
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`Defendant Insurance Specialists, Inc. (“ISI”) is a Georgia corporation,
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`authorized to do business in the Commonwealth of Massachusetts, having a place of
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`business at 2964 Peachtree Road, NW, Suite 105, Atlanta, Georgia and a registered agent
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`in this Commonwealth as Registered Agent Solutions, Inc. 44 School Street, Suite 505,
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`Boston, Suffolk County, Massachusetts.
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`JURISDICTION AND VENUE
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`4.
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`Personaljurisdiction is predicated against MetLife asit has an office in Suffolk
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`County, Massachusetts, and ISI has a resident agent in Suffolk County, Massachusetts.
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`5.
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`This action involves a controversy exceeding fifty-thousand dollars ($50,000.00).
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`FACTS COMMON TO ALL COUNTS
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`6.
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`ISI doing business as The ISI Insurance Trust entered into group contract number
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`151697-1-G with MetLife.
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`7.
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`MetLife issued a certificate dated April 1, 2017 providing for disability insurance
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`coverageto certificate holders under the policy providing for long-term disability
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`insurance coverage (“LTD Plan’).
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`8.
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`ISI as the policyholder, is a necessary party to afford complete relief to Ms.
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`Brennan.
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`9.
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`Ms. Brennanis a certificate holder under the LTD Plan.
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`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`10.
`
`Ms. Brennan had to cease working in her occupation as a lead business analyst,
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`because she wasstricken with COVID-19, and the symptomsofherillnesss prevented
`
`her from working in her occupation.
`
`11.
`
`Although Ms. Brennan survived the acute stage of the illness, COVID-19 hasleft
`
`her with debilitating symptoms, including severe fatigue, shortness of breath, reduced
`
`dexterity, and memory recall impairment, that make it impossible for Ms. Brennan to
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`think clearly and remember new information andto fulfill her prior occupational duties.
`
`12.
`
`Ms. Brennanfiled a claim for benefits under the LTD Plan.
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`13.—Byletter dated May 24, 2021, MetLife determined that after Ms. Brennanleft
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`work on January 12, 2021, she met the 60-day elimination period and MetLife began
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`paying LTD benefits beginning on March 14, 2021 in the amount of $6,279 per month.
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`14.=MetLife terminated LTD benefits on November 9, 2021 although Ms. Brennan’s
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`health had not improved.
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`FIRST CAUSE OF ACTION
`
`BREACH OF CONTRACT AGAINST METLIFE
`
`16.
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`Mr. Brennanrealleges the preceding paragraphs and incorporates the same by
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`reference as if fully set forth herein again.
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`17.
`
`Underthe terms of the LTD Plan:
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`Disabled or Disability means that, due to Sickness oras a direct result of
`accidental injury:
`
`e You are receiving Appropriate Care and Treatment and complying with the
`requirements of such treatment; and
`e You are unable to earn more than 80% of Your Predisability Earnings at Your
`Own Occupation
`
`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`18.
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`Atall times material hereto, Ms. Brennan was disabled under the terms of the
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`LTD Plan and remainsdisabled to date.
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`19.
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`The decision to deny benefits by MetLife was wrongful and not in compliance
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`with laws and the terms of the LTD Plan.
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`20.
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`ISI agreed to provide long-term disability coverage to Ms. Brennanasa certificate
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`holder of the group policy.
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`21.
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`Asadirect and proximate result of MetLife’s breach of contract under the LTD
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`Policy, MetLife caused damages to Ms. Brennan.
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`22.
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`MetLife owes Ms. Brennannoless than $6,279 per month since the date MetLife
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`terminated benefits and through the current date.
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`SECOND CAUSE OF ACTION
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`BREACH OF THE COVENANT OF GOOD FAITH AND FAIR DEALING
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`AGIANST METLIFE
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`23.
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`Ms. Brennan repeats andrealleges the allegations set forth above and incorporates
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`the sameby reference herein.
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`24.
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`25.
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`The duty of good faith and fair dealing applies to insurance contracts.
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`There is an implied covenant of good faith and fair dealing in every contractthat
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`neither party will do anything to injure the right of the other party to the contract to
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`receive the agreement’s benefits.
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`26.
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`Even before the passage of Chapters 93A and 176D, an insurer had an obligation
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`to act in goodfaith, to “exercise common prudenceto discoverthe facts as to liability and
`
`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`damages upon which anintelligent decision may be based.” Murach v. Massachusetts
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`Bonding andIns. Co., 339 Mass. 184, 187(1959).
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`27.|Aparty to a contract may violate the implied covenant of good faith and fair
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`dealing without breaching the termsofthe contract so long as it harmedthe right of the
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`other party, in this case, Ms. Brennanto receive benefits underthe contract.
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`28.
`
`MetLife breached the covenant of good faith and fair dealing implied in the terms
`
`of the Certificate of Insurance and underthe laws of the Commonwealth of
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`Massachusetts by failing to pay benefits due to Ms. Brennan and denying insurance
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`coverage to Ms. Brennan as she reasonably expected.
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`29.
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`Asa direct and proximate result of the acts and omissions of MetLife in refusing
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`to pay benefits to Ms. Brennan after November9, 2021, she suffered damages.
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`30.|MetLife owes Ms. Brennan noless than $6,279 per month since the date it
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`terminated benefits and through the current date.
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`THIRD CAUSE OF ACTION
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`VIOLATION OF M.G.L. C. 93A AND C. 176D
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`AGAINST METLIFE ANDISI
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`31.
`
`Ms. Brennanrepeats andrealleges the allegations set forth in paragraphs above
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`and incorporates the sameby reference herein.
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`32. At all times material hereto, both MetLife and ISI have been engagedin trade or
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`commerce within the Commonwealth of Massachusetts as those terms are defined
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`under G.L. c. 93A.
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`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`33. On January 31, 2023, Ms. Brennan sent a “Demand Letter” seeking relief under
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`G.L. c. 93A and c. 176D separately to both MetLife and ISI. A copyofthe letter,
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`without exhibits, is attached as EXHIBIT A.
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`34. MetLife failed to respond to the DemandLetter.
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`35.
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`ISI made an inadequate response to the Demand Letter and did not offer monetary
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`relief or other suitable relief that will limit its hard to Ms. Brennan.
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`36.
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`Both MetLife and ISI engaged in deceptive acts and practices, substantially within
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`the Commonwealth of Massachusetts, which violated both G.L. c. 93A and c. 176D,
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`as set out in detail in the demandletter.
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`37. The unfair and deceptive acts and practices of MetLife and ISI were performed
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`willingly and knowingly as explained in EXHIBIT A.
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`38. Both MetLife and ISI materially violated G.L. c. 93A and c. 176D by its oppressive
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`acts and omissions, by MetLife’s failure to pay benefits to Ms. Brennanafter
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`November9, 2021, and by ISI by failing to exercise duties to protect persons insured
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`under the LTD plan,by assisting insureds, including Ms. Brennan, from unfair and
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`deceptive practices perpetrated by MetLife in administering her disability claim.
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`39. Asa direct and proximate result of the acts and omissions of both MetLife andISI,
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`Ms. Brennan suffered damages.
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`40. MetLife’s and IDI’s conduct violated c. 176D and Ms. Brennanis entitled to treble
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`damages, attorney’s fees, costs and other relief under c. 93A.
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`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`DEMANDS FOR RELIEF
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`WHEREFORE, the Plaintiff prays for judgmentas follows:
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`A.
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`Award damages against the Defendant Metropolitan Life Insurance Company in
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`an amount which this Court shall determine to be necessary and proper to compensate
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`Plaintiff for her damages together with pre-judgmentinterest from the date of breach of
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`contract, post-judgment and reasonable attorneys’ fees, and costs.
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`B.
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`Awardto the Plaintiff punitive damages against the Defendant Metropolitan Life
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`Insurance Company for violating the covenant of goodfaith and fair dealing and engaging
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`in bad faith insurancepractices.
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`C.
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`Awardto the Plaintiff against both Defendants, including treble damages under
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`G. L. c. 93A, together with pre-judgment interest from the date of breach of contract,
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`post-judgmentinterest, reasonable attorneys’ fees, and costs.
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`D.
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`Reinstate benefits plus award pre-judgmentinterest, post-judgmentinterest, costs
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`and reasonable attorneys’ fees allowed by statute or otherwise.
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`E.
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`Declaring that both Defendants have repudiated the Certificate of Insurance by
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`refusing to pay all sums due andaccelerate all benefits over Plaintiff's maximum benefit
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`period reduced to present value and payable immediately.
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`F.
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`For such other and furtherrelief as this Court deemsjust and proper.
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`
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`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
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`PLAINTIFF CLAIMS TRIAL BY JURY ON ALL ISSUES SO TRIABLE.
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`Respectfully submitted.
`
`JANET BRENNAN
`
`BY:
`
` /s/ Jonathan Feigenbaum
`Jonathan Feigenbaum (BBO
`#546686)
`184 High Street, Suite 503
`Boston, MA 02110
`jonathan@erisaattorneys.com
`T: (617) 357-9700
`F: (617) 227-2843
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`184 High Sereet
`7
`The Law Offices of |
`JONATHAN M. FEIGENBAUM|Suite 50
`ae—
`ERISA
`|
`Health
`|
`Life
`[|
`Disabilicy
`[|
`Insurance
`
`Boston, MA 02110
`
`T(617) 357-9700
`F (617) 227-2843
`www,erisaattorneys.com
`
`jonathan@erisaattorneys.com
`
`Christine Dewey
`Appeals Specialist
`MetLife
`P.O. Box 14592
`Lexington, KY 40512-4592
`
`William K.Bass,Jr.
`Insurance Specialists, Inc.
`2964 Peachtree Rd NW,Suite 105
`Atlanta, GA 30305
`
`January 31, 2023
`CERTIFIED MAIL
`
`FEDEX
`
`Re:
`
`:
`Insured
`Claim Number:
`Plan
`:
`
`Group Policy :
`TPA
`:
`Insurer
`:
`
`Janet Brennan, Newton, Massachusetts
`762102246751
`The ISI Insurance Trust Certificate Dated: April 1, 2017
`(“LTD Plan’)
`151697-1-G
`Insurance Specialists, Inc. (“ISI”)
`Prior to December 1, 2022 Metropolitan Life Insurance Company
`(“MetLife”)
`
`Dear Ms. Dewey and Mr. Bass:
`
`I am counsel to Ms. Brennan. I am including a paper authorization for MetLife and Mr.
`Bass to communicate with me on behalf of Ms. Brennan. All contact from yourreceipt ofthis
`letter should be through me. Kindly do not contact Ms. Brennan until you receive written
`permission from me.
`
`This letter is as a pre-suit Consumer Demand Letter under Mass. Gen. Laws ch. 93A, § 9.
`MetLife’s decision to refuse to pay Total Disability benefits to Ms. Brennan is unreasonable and
`contrary to the substantial evidence that shows she cannot workfull time in her prior occupation
`as a Lead Business Analyst.
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`I am writing to Mr. Bass requesting that he contact MetLife and direct MetLife to
`reinstate benefits. As a third-party administrator, ISI has duties to protect persons insured under
`LTD. These duties include assisting insureds, including Ms. Brennan, from unfair and deceptive
`practices perpetrated by MetLife in administering her disability claim. Althougha letter from
`Mr.Bassstates that the insurance carrier for new claims effective December 1, 2022 is New
`York Life, the letter also states that claims arising prior to December 1, 2022 remain the
`obligation of MetLife. In addition, the LTD Plan provides:
`
`While You are Disabled, the benefits described in this certificate will not be affected if:
`* Your insurance ends; or
`* the Group Policy is amended to changethe plan of benefits for Yourclass.
`
`If either ISI or MetLife takes a position that New York Life Insurance Company may be
`liable to pay Ms. Brennan’s claim, then please advise at once in writing.
`
`1.
`
`Summaryclaim history based on Ms. Brennan’s occupationalduties.
`
`By way of background, Ms. Brennan worked at FM Global of Johnson, RhodeIsland,
`through Intepros Consulting in Lexington, Massachusetts. Her occupation is described as a lead
`business analyst. Ms. Brennan describes the position requiring responsibility for the collection,
`evaluation, understanding, documentation and communication of business requirements involved
`in the development of new or the modification and support of existing enterprise-software,
`business applications. The occupation required many non-exertional duties that MetLife failed to
`consider when it terminated Ms. Brennan’s long-term disability (“LTD benefits”). It appears that
`MetLife incorrectly focused on physical exertional duties to the exclusion of non-exertional
`duties.
`
`Being a lead business analyst involved the following:
`e Lead software requirementselicitation, definition, testing, training, implementation,
`and support of enterprise-wide business applications.
`e Elicit business requirements through interviews, workshops and/or existing system
`documentation and procedures.
`e Use industry standard analysis techniques to uncover business requirements, such as
`data flow modeling, use case scenarios, and workflow analysis using industry
`standard softwaretools.
`e Documentthe results of analysis activities using established processes, templates and
`software tools.
`Provide recommendations for improvements to business analysis practices, processes,
`templates andtools.
`Perform data analysis and data element mapping to software services and or
`databases.
`e Work with other development groups when software developed must integrate with
`other software applications and to ensure integrated business solutions are planned
`for, developed andtested.
`e Lead business analysis activities on large and complex projects.
`2
`
`e
`
`e
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`e
`
`Plan, coordinate and execute end to end testing of software solutions across integrated
`applications.
`e Represent business perspective and needs on project teams to insure that software
`developed meets business goals and supports businessusers.
`e Monitor agile team on good business analysis practices and techniques.
`e Mentor more junior business analysts.
`e
`Becomeproficient quickly in the use of new software tools as corporate standards
`change.
`
`A. The occupational duties required, once a project was underwayto include:
`
`1. Work with all levels of business partners and subject matter experts (SMEs) from entry
`level clerks to corporate senior management.
`2. Quickly review and understand complex business procedural documents, insurance
`underwriting standards, create business process workflow diagramsandothervisual aids
`for use in requirementelicitation sessions.
`3. Developa list of initial questions usedto elicit all details for business requirements
`including but not limited to, who are the users, what are their roles, approval hierarchy,
`security and user access permissions byrole, business rules that allow or limit
`combination of user actions.
`4. Coordinate individual user interviews and workshopsto elicit all requirements and
`make sure that usersofall levels in the corporation have their needs addressed.
`5. Determine if any additional data elements are required from other corporate systems
`and work with the related development team to get our requirements into their pipeline.
`Escalate issuesif their development timeline does not meet my team’s needs.
`6. Determine if any additional data elements are required to feed to other systems(e.g.,
`for corporate reporting or other needs) and work with the related development team to get
`our requirements into their developmentpipeline. Escalate issues if their timeline does
`not meet my team’s needs.
`7. Negotiate changes to business processes with business partners when the automation of
`functions provides an opportunity to replace manual steps with automation via the
`software (e.g., having the software preventerrors or validate and perform necessary
`checks for accuracy instead of current manually peer reviews and approvals).
`8. Quickly and concisely document business requirements in the approved template
`format.
`9. Review business requirements with the development team including software
`developers, user interface experts and quality assurance testing personnel on the
`development team. Work with the team to break up the requirements into chunks of work
`that can be completed in 2 week periods.
`10. Communicate with business partners and subject matter experts to set expectations
`for how they will receive beta versions of the software for their review. After their
`review, go back to the development team with any changes to developmentplans
`requested by the business/SMEsto reassess and adjust delivery schedule. Communicate
`negotiated changes to the delivery schedule to the business/SMEsand repeat this process
`until both the business/SMEs and development team are in agreement.
`
`3
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`B. After the business partners or subject matter experts approve the requirements
`and the project is entering the developmentphase, the duties required:
`
`1. Continue to support development by answering questions from developers, user
`interface (UI) experts and QA. ReviewQAtest plans to ensurethat all aspects of the
`developed software are tested including security, permissions, feature options,etc.
`based on whatis in the requirements.
`2. Work with UI experts to ensure their designs for application screens users will use
`meet the business requirements.
`3. Attend daily stand up meetings to review how team membersare progressing with
`their tasks, who is on target, ahead of schedule or running late and needing more
`resources.
`
`4. Work with other teams for consumption of data elements or transmission of data to
`their systems to make sure they understand the requirements. Escalate to my
`managementif their timeline does not our needs.
`5. Attend defect (bug) triage meetings to determine if a reported defect found through
`testing is indeed a bug,prioritize the defects according to business needs and
`difficulty in fixing the issue.Take an assignmentto recreate a bug if additional
`research is needed in orderto verify it is a bug andto prioritize the defect.
`6. Attend defect meetings with other teams where weneedto receive or send data if
`they alert me to defects they find in that area. Provide updates to my development
`team and notify them of any additional work needed on ourend.
`7. Makesure testing on our side is done to receive and send data from and to any other
`systems and report defects to respective teams as needed.
`8. Assist with testing and development of additional test plans and finding data to use in
`testing as needed.
`9. Plan and begin any training that is needed. Develop the training materials or work
`with the training departmentto introduce them to the project, help them develop the
`training materials and review their work. Conductthe training or provide constructive
`feedback to trainer duringatrial run rehearsal.
`10. Communicate with the business/SMEson progress of developmenteffort.
`Communicate and negotiate with the business/SMEsfor any changes that may be
`needed due to complexities of software development discovered by developers that
`impacts the timeline for completion and negotiate either a change to requirements or a
`timeline extension.
`11. Support the business/SMEstesting of the software solution once the product of a 6
`week developmenteffort is turned over to them for their use, review and approval.
`Document requirements for and take back to the development team any changesor
`improvements the business/SMEsrequest. Work with the development team to size
`and prioritize the changes. Communication and negotiate with the business/SMEs and
`developers until new requirements development timeline is agreed upon.
`12. Cycle repeats until the business/SMEsapprovethe software product.
`13. Once approved, present the business purpose for and demonstrate the use of the
`software product or changes to a wide audience of business partners and development
`teams.
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`O . Other occupational duties required working in an environmentthat included:
`
`WPwWnh
`
`Working on existing projects and development projects
`Working in an open noisy environment.
`Frequent interruptions by co-workers.
`Emergencyattention to address software defects discovered by co-workers.
`Providing feedback to co-workers.
`
`She has had a successful career and she was exceptionally high-achieving. Unfortunately,
`she wasafflicted by COVID-19, and she has never recovered. Although she survived the acute
`stage of the illness, COVID-19 hasleft her with debilitating symptoms, including severe fatigue,
`shortness of breath, reduced dexterity, and memoryrecall impairment, that make it impossible
`for Ms. Brennanto think clearly and remembernew information. Muchto herdistress, Ms.
`Brennan finds that she is one of the COVID-19 long-haulers, who continue to experience
`debilitating symptoms long after their acute COVID-19 infection has passed.
`
`Despite her best efforts, Ms. Brennan could no longer understand the complex matters
`that her job required her to handle, and she was so chronically exhausted. This is why she
`applied for and was granted LTD benefits by MetLife. Unfortunately, although Ms. Brennan
`very much wants to return to work,it is unclear when her symptomswill resolve. COVID-19 is
`a newillness, and scientists are just beginning to understandits long-term impacts.
`Ms.Brennan’s doctor has diagnosed her with chronic symptoms. At this early stage in the study
`of COVID-19, however, there is not yet a formal diagnosis to capture all of Ms. Brennan’s post-
`COVID symptoms. Patients like Ms. Brennan are described as COVID-19 “long-haulers” — a
`phenomenon which has been widely reported in the media. Dr. Anthony Fauci, MD, director of
`the National Institute of Allergy and Infectious Diseases, has said that “there’s no question”that
`a “considerable” numberof post-COVID patients “have a postviral syndromethatreally, in
`many respects, can incapacitate them for weeks and weeks following so-called recovery and
`clearing of the virus.”! One study has found that about 10% of people who have had COVID-19
`experience prolonged symptoms, and that these are often people who — like Ms. Brennan — had
`mild to moderate COVID-19 infections.” Time Magazinereportsthat “Even young, healthy
`people can become long-haulers (as many call themselves), left unable to work, lead a normal
`life or, some days,get out of bed.”? Manyof the long-haul symptomsdescribed in the press
`mirror Ms. Brennan’s: fatigue, shortness of breath, brain fog, and fatigue. Some doctors,
`including Dr. Fauci, have noted that the COVID-19 long-haul symptomsare similar to Myalgic
`Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)! — echoing Dr. Tostado’s diagnosis of
`Chronic Fatigue. Whatever name the post-COVID syndromewill eventually be given, the fact
`that it exists is well-established. As JAMAhasreported, Stanford University neurologist
`
`1 Rita Rubin, “As Their Numbers Grow, COVID-19 ‘Long Haulers’ Stump Experts,” Journal of
`the American Medical Association (JAMA), vol. 324, no. 14 (October 13, 2020), enclosed.
`* Id., see also Ed Yong, “Long-Haulers Are Redefining COVID-19,” The Atlantic (August 19,
`2020), enclosed.
`> Jaime Ducharme,“Some Coronavirus Patients Are Reporting Symptomsthat Last Months,”
`Time (August 18, 2020).
`4 Td.
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`Mitchell Miglis, MD, states that although scientists don’t yet fully understand the post-COVID
`syndrome,it’s clear that “these mystery diagnosesare real.”° As with mostdisability insurance
`disputes, the precise diagnosis is not determinative. The pertinent issue is how do the symptoms
`impact work functionality.
`
`Even though long-COVIDis not yet in the ICD-10, courts recognize that a claimant may
`be disabled and entitled to benefits even whenthere is not a clear diagnosis. See, e.g., Al-Abbas
`v. Metro. Life Ins. Co., 52 F. Supp. 3d 288, 290-291 (D. Mass. 2014) (finding that insurer acted
`unreasonably in denying benefits where the plaintiff had long-term chronic fatigue and cognitive
`dysfunction, with no definitive diagnosis, and holding “the focus should properly have been on
`her functionallimitations, if any, not the specificity of her diagnosis”); Bunger v. Unum Life Ins.
`Co. ofAm., 299 F. Supp. 3d 1145, 1163-64 (W.D. Wash. 2018), (finding in favorof a plaintiff
`with chronic fatigue symptoms of unknownorigin andstating “Whetheras a result of CFS,
`fibromyalgia, or another condition, a preponderance of the evidence shows Mr. Bungerhad a
`sickness precluding his ability to perform the high level of mental functioning required for the
`performanceofhis job [...]””). Here, the cause of Ms. Brennan’s symptomsare clear andit is
`simply a matter of time before a formal diagnosis name and codeare settled uponfor this post-
`COVID condition.
`
`Giventhese facts, by letter dated May 24, 2021, MetLife determinedthat after Ms.
`Brennan left work on January 12, 2021, she met the 60-day elimination period and MetLife
`began paying LTD benefits beginning on March 14, 2021 in the amount of $6,279 per month.
`MetLife terminated LTD benefits on November 9, 2021. This was a mistake by MetLife. Ms.
`Brennan tendered new information to MetLife. By letter dated April 8, 2022, reaffirmed its prior
`termination.
`
`Between the date that MetLife awarded LTD benefits and terminated LTD benefit
`payments, Ms. Brennan’s health never improved. For the reasons explained below, MetLife’s
`decision to terminate LTD benefits was both factually and legally wrong and a violation of
`Massachusetts law. MetLife may correct its mistaken conduct by providing the relief requested at
`the end ofthis letter. In support of this appeal, Ms. Brennan is supporting medical information
`about her health condition and a great deal of information about long haul covid andits
`symptoms.
`
`I.
`
`Documents included with this letter on the enclosed CD-ROM in support of
`This Consumer DemandLetter.
`
`A. Disability Income Insurance: Long Term Benefits Certificated Dated: April 1,
`2017
`B. October 24, 2022 letter by William K. Bass,Jr.
`C. Final denial letter from MetLife dated April 8, 2022.
`
`5 Rubin, enclosed.
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`zcOm
`
`. Patient Assessment form describing details of inability to do occupational
`duties and symptoms.
`Tamara G. Fong, MD, Ph.D. concurrence of accuracy of Patient Assessment
`dated November 21, 2022.
`Updated medical records.
`. Detailed Occupation description for Lead Business Analyst with hour-by-hour
`duty description
`. Transcript of conference call with top managementat Hartford Financial
`Services Group, Inc. acknowledging the reality of long COVID-19.
`Board of Registration in Medicine opinion regarding practice of medicine
`when opining on Massachusetts resident.
`Treating physician list and contact information.
`. Prescription chart identifying medications and dosages.
`Sworn declaration of Ms. Brennan
`. Sworn declaration of Mr. Brennan
`Sworn declaration of Paula Proctor, friend of Ms. Brennan for 28 yearsplus.
`. Atlantic Magazine Article on COVID-19.
`COVID-19 MayoClinic — twoarticles
`COVID-19 Science Direct.
`COVID19 American Psychological Association.
`COVID-19 Johns Hopkins Medicine.
`Post COVID Conditions Centers for Disease Control.
`. Long COVID New York Timesarticle.
`. Long COVIDtreatment program at UCLA.
`. Post COVID-19 burden and managing symptoms — Springer Lake.
`. Symptoms, complications and managementof long COVID: a review in the
`Royal Society of Medicine — United Kingdom
`
`—H
`
`
`
`ESCHYROMOZEORA
`
`Summary of each key LTD Plan terms.
`
`Specific to Ms. Brennan’s age, the LTD Plan provided benefits up to age 66 and 6
`months given her date of birth and onset of disability.
`
`Disabled or Disability means that, due to Sickness or as a direct result of accidental
`
`You are receiving Appropriate Care and Treatment and complying with the
`requirements of such treatment; and
`You are unable to earn more than 80% of YourPredisability Earnings at Your Own
`Occupation
`
`If You are Disabled and have received a Monthly Benefit for 12 months, We will adjust
`YourPredisability Earnings only for the purposes of determining whether You continue
`
`7
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`to be Disabled and for calculating the Return to Work Incentive, if any. We will make the
`initial adjustment as follows:...
`
`Appropriate Care and Treatment means medical care and treatment thatis:
`* given by a Physician whose medicaltraining and clinical specialty are appropriate for
`treating Your Disability;
`* consistent in type, frequency and duration of treatment with relevant guidelines of
`national medical research, health care coverage organizations and governmental agencies;
`* consistent with a Physician’s diagnosis of Your Disability; and
`* intended to maximize Your medical and functional improvement.
`
`Own Occupation meansthe essential functions You regularly perform that provide Your
`primary source of earned income.
`
`OPTIONAL LONG TERM BENEFIT: COST OF LIVING ADJUSTMENT
`If You have been receiving Monthly Benefits underthis certificate, We will adjust Your
`benefit amount on the date following the date the 12th Monthly Benefit is payable. As
`limited by the Maximum Benefit Period, further adjustments will take effect on each
`anniversary ofthe first adjustment. The total number of adjustments may not exceed 10.
`
`Physician means:
`* a person licensed to practice medicinein the jurisdiction where such services are
`performed; or
`* any other person whoseservices, according to applicable law, must be treated as
`Physician’s services for purposes ofthe Group Policy. Each such person must be licensed
`in the jurisdiction where he performs the service and must act within the scope ofthat
`license. He mustalso be certified and/or registered if required by such Jurisdiction.
`
`Proof means Written evidence satisfactory to Us that a person hassatisfied the conditions
`and requirements for any benefit described in this certificate. When a claim is made for
`any benefit described in this certificate, Proof must establish:
`* the nature and extent of the loss or condition;
`* Our obligation to pay the claim; and
`* the claimant’s right to receive payment.
`Proof must be providedat the claimant's expense.
`
`Sickness meansillness, disease or pregnancy, including complications of pregnancy.
`
`IV.
`
`Disability income insurance: long term benefits.
`
`The LTD Plan provides:
`
`If You becomeDisabled while insured, Proof of Disability must be sent to Us. When We
`receive such Proof, We will review the claim. If We approve the claim, We will pay the
`8
`
`
`
`Date Filed 5/1/2023 5:57 PM
`Superior Court - Suffolk
`Docket Number
`
`EXHIBIT A
`
`Monthly Benefit up to the Maximum Benefit Period shown in the SCHEDULE OF
`BENEFITS, subject to the DATE BENEFIT PAYMENTSENDsection.
`
`To verify that You continue to be Disabled withoutinterruption after Our initial approval,
`Wemayperiodically request that You send Us Proof that You continue to be Disabled.
`Such Proof may include physical exams, exams by independent medical examiners, in-
`homeinterviewsor functional capacity exams, as needed.
`
`While Youare Disabled, the Monthly Benefit described in this certificate will not be
`affected if:
`* Your insurance ends; or
`* the Group Policy is amended to changethe plan of benefits for Yourclass.
`
`Underthis provision Ms. Brennan, MetLife had an obligation to continue paying benefits
`given that she met the definition of disability. She was receiving appropriate care from a
`physician at all times and her incomehad dropped to zero. The cause of her income lass were
`symptoms of COVID-19.
`
`V.
`
`The third-party administrator has duties arising under the plan insured by
`MetLife.
`
`William K.Bass, Jr, of Insurance Specialists, Inc., represents:
`
`Insurance Specialists, Inc. (ISI) is a Third Party Administrator which has provided
`programsfor affinity groups for over half a century. Founded in Atlanta, Georgi