Welsh v. Metropolitan Life Insur. Co., 2000 U.S. App. LEXIS 16172 (9th Cir. July 11, 2000) (Unpublished)

Welsh v. Metropolitan Life Insur. Co., 2000 U.S. App. LEXIS 16172 (9^th Cir. July 11, 2000) (Unpublished)-This court reversed the district court's grant of summary judgment against Welsh since MetLife abused its discretion when it denied his claim for long-term disability benefits. This court found that the plan administrator never properly evaluated Welsh's claim in light of the plan's definition of "disability." The plan definition contained an additional prong which granted disability status to someone who could perform "at least one of the material duties of your regular job" but was "earning currently at least 20% less per month . . . due to that Injury or Sickness." MetLife apparently never considered Welsh's eligibility under this prong.

Additionally, MetLife's reviewing doctor was told neither the definition of disability nor the material duties of Welsh's job. "Given this lack of information, Dr. Petrie's conclusion that Welsh was not disabled under the plan was pure speculation."

The Court remanded with the instructions that the District Court shall order MetLife to reexamine Welsh’s claim applying the correct definition of disability and allow Welsh to supply records as necessary.