Court Rules in Favor of Retroactive Disability in Dharmasena v. MetLife

In the interesting ERISA case of Dharmasena v. Metropolitan Life Insurance Company, 2025 WL 1563970 (C.D. Cal. May 29, 2025), Judge Jesus G. Bernal of the U.S. District Court for the Central District of California ruled in favor of the plaintiff, Hettihewage Dharmasena, reversing MetLife’s denial of long-term disability (LTD) benefits. This case highlights critical issues in ERISA disability litigation, especially surrounding retroactive disability claims and the evidentiary weight of a favorable Social Security Administration (“SSA”) disability determination. It also reinforces that working up to one’s date of termination does not automatically preclude a finding of disability under the terms of a long-term disability policy.

The Plaintiff’s Claim and the Denial

Dharmasena was a long-time electrical engineer for Schneider Electric when he began to suffer from progressive symptoms of facioscapulohumeral muscular dystrophy, a rare genetic neuromuscular condition. Despite significant physical limitations—including atrophied muscles, impaired mobility, and the need for assistive devices—Dharmasena continued working until his termination on February 4, 2022.

When he applied for LTD benefits from MetLife, the insurer denied the claim on procedural grounds, asserting that Dharmasena’s disability began on February 7, 2022—after his employment and coverage had ended. The denial rested on the assumption that a claimant must stop working due to disability before losing coverage. However, the Court held this reasoning was flawed.

Retroactive Disability: The Key Legal Turning Point

A central issue was whether Dharmasena could be considered disabled before his last day of work, despite his continued employment. The Court ruled that a claimant may be retroactively found disabled, even while still employed. “There is no brightline rule that an employee must claim disability before being terminated to receive long-term benefits,” the Court stated, citing Woo v. Deluxe Corp., 144 F.3d 1157, 1162 (8th Cir. 1998) and Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 918 (7th Cir. 2003).

Judge Bernal clarified that “last day worked” is not the same as the “date of disability.” Under the terms of MetLife’s plan, a participant is “disabled” if they are “unable to earn” more than 80% of their predisability earnings due to illness or injury—regardless of whether they were still on payroll. The Court emphasized that a person can “force himself to work despite an illness that everyone agreed was totally disabling.”

Objective Medical Evidence and the Role of the Treating Physician

The Court gave significant weight to the observations of Dharmasena’s treating physician, Dr. Win, who examined the plaintiff on February 8, 2022—just four days after his termination. Dr. Win noted that Dharmasena “was very weak and cannot walk at all,” could not push a wheelchair, and was unable to use a computer due to upper extremity atrophy.
“Even accepting Defendant’s argument that Plaintiff only needed to sit, use a mouse, and input code for a job,” Judge Bernal wrote, “if Plaintiff cannot sit or use his upper extremities, Plaintiff was disabled…within the meaning of the Plan.”

This real-time clinical assessment, combined with Dharmasena’s long treatment history and consistent functional evaluations, provided compelling support for a retroactive disability finding as of February 4, 2022.

The Significance of the SSA Disability Determination

One of the most impactful holdings of the case was the Court’s treatment of the SSA’s disability finding. Dharmasena had been awarded Social Security Disability benefits, with the SSA agreeing that his disability began on February 4, 2022—the very date MetLife sought to disqualify. Judge Bernal called the SSA’s decision “weighty evidence,” noting that: “The requirements for disability under the SSA are stricter than the Plan.”

While MetLife argued that the SSA did not thoroughly investigate the disability onset date, the Court rejected this claim, explaining that the SSA’s determination was consistent with the medical record. As a result, the SSA’s conclusion bolstered the Court’s finding that Dharmasena was indeed disabled before his termination.

De Novo Review and Remand Rejected

Because the Court reviewed the denial de novo, it was empowered to make its own findings without deference to MetLife’s prior decision. Judge Bernal found that remanding the case back to MetLife for further review would only delay justice: “Both sides have had a fair opportunity to argue their views on whether Plaintiff was disabled under the Plan, and the Court sees no reason to delay Plaintiff’s review further.”

Key Takeaways for Claimants and Practitioners

• Working until termination does not bar a disability claim. Courts recognize that employees may struggle to remain employed even while disabled.
• Retroactive disability claims are viable if the claimant can show, by a preponderance of the evidence, that they met the Plan’s definition of disability before coverage ended.
• Treating physician opinions and clinical contemporaneous evaluations carry significant weight under ERISA, especially when based on long-term treatment relationships.
• SSA disability awards matter. Even though they arise under a different legal standard, federal courts often give considerable weight to SSA findings in ERISA litigation.
• Procedural denials based solely on last work date can be overturned. A plan administrator cannot equate “last day worked” with “not disabled.”

Conclusion

Dharmasena v. MetLife serves as a strong reminder that ERISA disability determinations must be rooted in substantive evidence—not procedural technicalities. For claimants facing denial because they worked “too long,” the case offers hope and legal precedent. As the Court put it plainly: “The best evidence of the reality of Plaintiff’s condition comes from the physician who actually examined Plaintiff.”