Kresich v. Metropolitan Life Insurance Company (MetLife) is a federal case out of the Northern District of California favorable to a plaintiff who was harassed, accused of lying and oppressed during the processing of his disability claim. Because of MetLife’s conduct, the plaintiff sued for intentional infliction of emotional distress (IIED). Despite MetLife’s vigorous argument that the claim was preempted by ERISA and the plaintiff could not pursue his tort action, the court disagreed and found in favor of the plaintiff. Relying on precedent, the court stated “Plaintiff’s IIED claim stems not from the handling and disposition of his claim, but from independent allegations of harassment and oppressive conduct. There is no alternative enforcement mechanism under ERISA by which Plaintiff could bring such a claim.”
Kreisich was a vice-president for Kaiser Permanent Controller when he had to quit work due to severe and chronic back pain. Pain medications caused him side effects so serious that he was unable to work. He filed a claim for disability with his insurer, MetLife. Even though MetLife eventually determined he was entitled to long term disability benefits, he filed suit in state court alleging that during the claims processing, MetLife:
• Intentionally delayed scheduling independent medical exams (IMEs).
• Intimidated him into attending multiple IMEs knowing the exams would cause him additional pain and emotional distress.
• Ignored his correspondence.
• Demanded time extensions.
• Accused him of lying about his pain and exaggerating it.
• Purposely misstated and misrepresented statements made by the plaintiff and his treating physicians.
• Put pressure on him to drop his claim, return to work and accept a smaller settlement than one to which he was entitled.
Plaintiff alleged that by these acts, MetLife “engaged in extreme and outrageous conduct by unnecessarily prolonging review of his claim and causing severe mental distress.”
MetLife removed the case to federal court and argued that plaintiff’s state claim was preempted by ERISA and he should not be allowed to pursue it. The court carefully analyzed precedent and determined IIED claims that do not depend on whether or not disability benefits have been awarded are not preempted.
The court pointed out that “ERISA provides a uniform regulatory regime over employee benefit plans.” This means that issues concerning whether or not a claimant is entitled to benefits must be brought under ERISA and decided according to ERISA rules and regulations. MetLife argued that based on this requirement, Kresich’s claims could only be decided under ERISA.
The court clarified that plaintiff’s claims did not concern whether or not he was entitled to benefits, which would be preempted by ERISA, but was independent of the processing since his claim for damages “remained regardless whether his claim for benefits was paid.” The court analyzed many similar cases where tort claims were allowed to proceed against the insurer. If not, then plaintiffs “would be subject to such treatment with no available recourse, and a plan administrator could investigate a claim in all manner of tortious ways with impunity.”
Since, in this case, the plaintiff “seeks damages from Defendant’s alleged harassing and oppressive conduct that existed wholly independent of the Plan…[and] his IIED claim does not depend on whether or not he was denied benefits” the plaintiff was allowed to pursue his IIED claim for damages against MetLife.
This case was not handled by our office, but it may provide claimants guidance in their pursuit of tort claims against their insurers when the insurer has engaged in wrongful conduct during the processing of the claim for disability benefits. If you need assistance with a similar matter, please contact any of our lawyers for a free consultation.