H v. MetLife: Your Rights to Long-Term Disability (LTD) Benefits – Even if You Were Still Working
Image inspired by Kandinsky, W. (1903). The Blue Rider. Oil on card. Private collection.
1. Introduction: Don’t Let Insurers Misinterpret Your Last Day at Work
At Dorian Law, we believe your long-term disability (LTD) claim should be decided by your actual medical condition and its impact on your ability to work—not by an arbitrary HR date or an insurer’s misinterpretation of your last day of employment. The recent U.S. District Court decision in Hettihewage Dharmasena v. Metropolitan Life Insurance Company, No. 5:23-cv-01510-JGB-DTB (C.D. Cal. May 29, 2025), is a powerful example of how courts uphold the rights of claimants under the Employee Retirement Income Security Act (ERISA).
While I didn’t brief or argue this case personally, I had the opportunity to work on it in my prior role at Kantor & Kantor. I share it here because it perfectly illustrates some key principles we fight for every day: that disability is about capacity—not just whether you’re still showing up to work—and that insurance companies can’t sidestep valid claims by playing games with coverage dates.
This landmark case clarifies three critical points often misunderstood by both claimants and insurance companies like MetLife:
Can you be considered “disabled” under an LTD plan even if you were still working when your employment ended?
What does the plan’s “unable to earn” standard truly mean for disability benefits?
How does “de novo” judicial review of ERISA claims empower courts to independently evaluate your disability evidence?
We’ll break down these crucial questions, citing the court’s own words and analyzing how this decision impacts individuals fighting for their rightful disability benefits.
Let’s start by tackling the first question: whether you can be considered disabled under an LTD plan if you’re still working at the time your employment ends.
2. Can You Be Disabled Under Your LTD Plan While Still Working? The Retroactive Disability Claim
Many individuals facing progressive medical conditions wonder: “Do I have to stop working completely before my employment ends to be considered disabled and eligible for benefits?” In H v. MetLife, the court definitively answered this, rejecting MetLife’s attempt to deny benefits based on the claimant’s last day worked.
The Court’s Stance: Judge Bernal explicitly stated: “A plaintiff could be disabled under the Plan without experiencing a loss of earnings and while still working continuously”.
Supporting National Precedent: The court reinforced this principle by citing well-established federal appellate court decisions:
Seventh Circuit (Hawkins v. First Union Corp., 326 F.3d 914): “There is no logical incompatibility between working full time and being disabled from working full time. A desperate person might force himself to work despite an illness that everyone agreed was totally disabling”.
Second Circuit (Locher v. Unum Life Ins. Co. of Am., 389 F.3d 288): “While a plaintiff’s continued employment certainly does not prohibit a retroactive disability claim, continued employment might weigh against a finding of disability”.
Eighth Circuit (Woo v. Deluxe Corp., 144 F.3d 1157): “There is no brightline rule that an employee must claim disability before being terminated to receive long-term benefits”.
Plain English Takeaway for Claimants: This means you can be considered legally “disabled” under your LTD plan even if you were technically working full-time up until your employment ended. Your disability is about your actual functional capacity and whether your medical condition prevents you from realistically performing your job duties, not solely about your last paystub or termination date. If you were pushing yourself beyond safe limits due to your condition, you may still be entitled to retroactive LTD benefits.
With that foundational principle established, let’s move on to the plan’s key term: “unable to earn.” What does it really mean, and how does it apply to your claim?
3. Understanding “Unable to Earn”: It’s About Functional Capacity, Not Just Wage Loss
The MetLife plan in H v. MetLife defined “Disabled or Disability” as being, among other things, “unable to earn... more than 80% of Your Predisability Earnings at Your Own Occupation” during the initial period. MetLife tried to argue that since the claimant was continuously employed and working with no loss of earnings through February 4, 2022, he wasn’t disabled.
The Court’s Clarification of “Unable to Earn”: The court rejected MetLife’s narrow interpretation, emphasizing that “the key term is ‘unable to earn’”. It clarified that this term aligns with the understanding that there is no logical incompatibility between working full time and being disabled from working full time.
Crucially, the court found that Mr. Dharmasena’s medical evidence showed he was “unable to sit or use his upper extremities”. Even if his job was considered sedentary (requiring him to sit, use a mouse, and input code), his medical limitations meant he “was disabled... within the meaning of the Plan” because he could not perform these essential functions.
Why This Matters for Your Claim:
For Claimants: Don’t let an insurer tell you that “you were still working, so you’re not disabled.” The focus is on whether your medical condition prevented you from truly performing the essential functions of your job at the required capacity.
For Lawyers: This ruling provides strong support for arguing that "unable to earn" is a functional standard. Your strategy should center on building a medical record that clearly demonstrates your client's physical and cognitive limitations, showing they could not perform their occupation, regardless of their employment status or paycheck.
Once you understand how “unable to earn” is interpreted, it’s essential to see how courts actually apply these principles in real-world cases. That’s where the de novo review standard comes in.
4. De Novo Review: The Court’s Independent Evaluation of Your Disability Claim
A pivotal aspect of the H v. MetLife decision is the court's application of "de novo" review. Under ERISA, this standard is applied "unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan".
What De Novo Review Means:
"The court does not give deference to the claim administrator’s decision, but rather determines in the first instance if the claimant has adequately established that he or she is disabled under the terms of the plan".
The court independently "evaluates the persuasiveness of each party’s case".
In Mr. Dharmasena's case, this meant the court could, and did, weigh the extensive medical evidence from his treating physicians—particularly the contemporaneous observations of his primary care doctor, Dr. Win—over MetLife's procedural denial. The court noted Dr. Win's observations that Mr. Dharmasena found it "very hard" to sit, "cannot use his upper extremity" , and later concurred with findings that he "cannot work at any physical demand level including any sedentary occupation".
Limits on Insurer Arguments (The Harlick Doctrine): The decision also touched upon the important principle from Harlick v. Blue Shield of California, 686 F.3d 699, 719 (9th Cir. 2012). This doctrine states that "a plan administrator may not fail to give a reason for a benefits denial during the administrative process and then raise that reason for the first time when the denial is challenged in federal court". This prevents insurers from shifting their denial rationale once litigation begins.
Key Takeaway for Claimants and Lawyers:
For Claimants: When your case is reviewed de novo, the court will look at all the credible evidence, not just what the insurance company decided. This means strong, consistent medical records from your treating physicians are paramount.
For Lawyers: This case reinforces the power of robust medical documentation, especially from treating doctors who conducted in-person observations. It also highlights the importance of holding insurers to the reasons they provided during the administrative appeal, preventing them from introducing new defenses in court.
Practice Tips for Lawyers:
🔹 Highlight treating physician opinions. Courts give great weight to detailed, contemporaneous medical observations—like Dr. Win’s findings in H v. MetLife—when deciding disability status under de novo review.
🔹 Anticipate the “still working” argument. Use cases like Hawkins, Locher, and Woo to show that working doesn’t defeat a claim—your client’s functional limitations are what matter.
🔹 Leverage Harlick. Cite Harlick v. Blue Shield of California to bar insurers from raising new defenses in litigation they didn’t identify during the administrative appeal.
Finally, here’s what this all means for you as a claimant—and for lawyers fighting these cases every day.
5. Conclusion: Your Medical Reality Should Define Your Disability, Not an Arbitrary Date
The H v. MetLife decision serves as a vital reminder that your right to long-term disability benefits under ERISA is fundamentally about your actual medical limitations and functional impairments, not your last paycheck or the precise date your employment ended. The court's willingness to look beyond procedural denials and evaluate the true extent of Mr. Dharmasena's disability offers significant hope for claimants.
If your insurance company—whether MetLife or another provider—has denied your LTD claim, particularly if they are arguing you weren't "disabled" because you kept working, this case demonstrates that such a denial is often not the final word.
6. Dorian Law: Your Partner in ERISA Long-Term Disability Claims
Based in California and proudly representing clients nationwide, Dorian Law has extensive experience litigating complex ERISA long-term disability claims. We understand the nuances of the "unable to earn" standard, the power of de novo review, and how to effectively challenge insurer tactics.
Are you facing a retroactive disability denial?
Has your insurer claimed you weren't disabled because you were still working?
Do you need expert legal guidance to navigate arbitrary coverage cutoffs and unfair denials?
We are here to help. Let's discuss how we can build the strongest possible case for your disability claim, grounded in compelling medical evidence and the legal standards that protect your rights.