Judge Upholds Coffee Cup Accident Benefits Denial

District Judge Rudolph T. Randa of the U.S. District Court for the Eastern District of Wisconsin rejected Natalie Koehler’s claims that Metropolitan Life Insurance Co. (MetLife) arbitrarily denied her benefits request as a beneficiary of her husband’s workplace accident insurance program.

Randa said in the ruling that Koehler sustained the injury to her left foot in November 1990, but did not file the MetLife claim until 14 years later.  

The judge said a doctor who evaluated the injury at MetLife’s request found Koehler could not voluntarily flex her left ankle and foot upward and that she had poor sensation in her left leg and foot. The doctor concluded that Koehler could walk with a foot drop brace and a cane, but had difficulty walking for more than 15 minutes at a time.

MetLife’s doctor responded by asserting that she had not experienced a permanent and total loss of function in her foot because she could press her foot downward. As part of her eventual appeal challenging the benefits denial, Koehler submitted 600 pages of medical reports documenting her various surgeries and previous doctor evaluations. MetLife again turned down Koehler’s claim for benefits.

Koehler eventually sued, claiming MetLife’s actions violated the Employee Retirement Income Security Act (ERISA).

The case is Koehler v. Metropolitan Life Insurance Co.,E.D. Wis., No. 06-C-0233, 7/2/07.