Kathy Dine received long-term disability benefits under an ERISA-governed plan after medical conditions rendered her unable to continue working. Her treating physicians continued to document functional limitations that interfered with sustained, full-time employment.
MetLife terminated benefits, asserting that Dine no longer met the plan’s disability definition. MetLife both evaluated claims and paid benefits under the plan, creating a structural conflict of interest. Kantor & Kantor challenged the termination as unsupported by the medical record and tainted by the insurer’s financial conflict.
The Ninth Circuit reversed the termination and remanded the case. On remand, the district court entered judgment reinstating benefits. The outcome reinforced that conflicted administrators must justify terminations with record-based reasoning and that courts will scrutinize termination decisions where insurers act as both judge and payor.
