James Seitz v. Metropolitan Life Insurance Company Merck & Co., Inc., Medical, Dental, and Long-Term Disability Program for Non-Union Employees

**Employee Wins Disability Benefits Case After Insurer's Denial** James Seitz worked for Merck and developed a medical condition that limited his ability to sit for long periods. His job required him to sit for 5-6 hours daily, but his condition restricted him to only 2 hours of sitting. When Seitz applied for long-term disability benefits through his employer's insurance plan (administered by MetLife), the company denied his claim. The federal appeals court ruled in Seitz's favor, finding that MetLife had abused its authority by denying the benefits. The court determined that since Seitz could not perform a key requirement of his job—sitting for the necessary hours—he qualified for disability benefits under the plan. The lower court had initially sided with MetLife, but the appeals court reversed that decision and sent the case back for further proceedings. This ruling matters for workers because it shows that insurance companies cannot arbitrarily deny disability claims when employees have clear medical limitations that prevent them from performing essential job functions. Workers who face similar situations—where a medical condition prevents them from meeting specific job requirements—may have stronger grounds to challenge denied disability benefits and should document how their limitations affect their work duties.