Talamantes v. Metropolitan Life Insurance Co., No. 20-50953 (5th Cir. 2021)
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After plaintiff filed suit under the Employee Retirement Income Security Act (ERISA) to recover long-term disability benefits from MetLife, the district court severed the coverage issue from the remaining issues. At issue in regards to coverage was whether Standard, the carrier for calendar year 2016, or MetLife, the carrier for 2017, provided coverage. The district court concluded that Standard, which had been previously dismissed, covered this claim.
The Fifth Circuit reversed, concluding that the court's reading of the Standard and MetLife policies lead it to conclude that Standard provided no coverage and coverage was afforded to plaintiff under MetLife's policy. The court explained that the Standard and MetLife policies outline how to transition coverage between old and new policies, as well as provide special rules for employees who temporarily recover during a transition. In this case, the plain language of the policies make it clear that plaintiff's benefits coverage for his alleged long-term disability shifted from Standard to MetLife. Accordingly, the court remanded for further proceedings.
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