Daic v. Hawaii Pacific Health Group Plan for Employees of Hawaii Pacific Health

# Daic v. Hawaii Pacific Health Group Plan **What Happened** An employee applied for long-term disability benefits through their employer's health plan managed by MetLife. The insurance company denied the benefits claim. The employee disagreed and took the case to court, arguing that MetLife's decision was unfair or improper. **What the Court Decided** The appeals court sided with MetLife and upheld the denial of benefits. The court found that MetLife followed the plan's rules correctly and made a reasonable decision based on the available information. The appeals court agreed with the lower court's earlier ruling. **Why This Matters for Workers** This case shows that when insurance companies deny disability benefits, courts give them significant leeway to make those decisions. Workers seeking benefits need strong evidence supporting their claims. If an employer's plan gives the insurance company discretion to decide benefit claims, courts are unlikely to overturn those decisions unless the company acted unreasonably or violated plan rules. Workers facing denied benefits should carefully gather medical documentation and understand their plan's specific requirements.