Metropolitan Life Insurance Company, also known as MetLife, offers a wide variety of insurance policies, including contracts for short term and long term disability insurance coverage. Disability insurance is intended to provide financial support if you became unable to work due to an injury or disability. Unfortunately, obtaining a disability insurance policy from MetLife does not guarantee that your claim for disability benefits will be approved.
After all, an insurance company is a business, and each claim paid reduces its profits. It may be troubling to think that even if you had to stop working due to a severe injury or illness, MetLife could still issue a disability claim denial. Even if you initially qualify for disability benefits, MetLife could wrongfully terminate your claim. Fortunately, claimants can fight back against wrongful MetLife disability denials by going through the appeals process.
Has Metropolitan Life (MetLife) Insurance Company Denied Your Disability Insurance Claim?
That’s where we come in. Nick Ortiz is a disability attorney with the knowledge and experience necessary to help you navigate the MetLife long term disability claim denial and appeals process. We’re here to pick up the fight against the insurance company so you can focus on what matters – your health. Call our office at (888) 321-8131 to schedule your free consultation today.
The Top Reasons for MetLife Disability Denials
Insufficient Evidence
Insurance carriers like MetLife frequently deny claims because there is insufficient evidence to support the claim. For example, in a case involving back pain, you may need an x-ray, or perhaps a better piece of evidence would be an MRI or a CT scan. In a mental illness claim, you may need a neuropsychological evaluation to verify cognitive deficits or difficulty thinking and processing information. This is the type of evidence that an insurance company is looking for in evaluating an LTD claim. A letter from your doctor simply stating that you are unable to work will not be sufficient.
Mental and Nervous Disorder Claims
Most policies limit the benefit period for claimants who are disabled due to a mental or nervous disorder. Here is an example from a MetLife policy:
If You are Disabled due to one or more of the following medical conditions described below, We will limit Your Disability benefits to a lifetime maximum equal to the lesser of:
- 24 months for one period of Disability during Your lifetime for any one or more, or all of the above conditions; or
- the Maximum Benefit Period.
Subject to the Administration of Limited Disability Benefits for Disability Due to Mental and Nervous Disorders or Diseases as set forth below:
Your Disability benefits will be limited as stated above for:
MetLife Long Term Disability Insurance Policy
- Disability due to alcohol, drug or substance abuse or addiction, We require You to participate in an alcohol, drug or substance addiction recovery program recommended by a Physician. We will end Disability benefit payments at the earliest of the period described above or the date You cease, refuse to participate, or complete such recovery program.
- Mental or Nervous Disorder or Disease that results from any cause, except for:
- Neurocognitive Disorders;
However, it is not uncommon for insurers to ignore a claimant’s physical limitations and focus primarily on mental limitations to terminate claims based on the mental and nervous disorder limitation.
Own Occupation vs. Any Occupation
Most MetLife policies have a definition of disability that changes after a certain period, typically 24 months. Disability benefits are often terminated after a change in definition occurs. Here is an example from a real MetLife Long Term Disability policy:
Disabled or Disability means that, due to Sickness or as a direct result of accidental injury:
You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and
You are unable to earn:
MetLife Long Term Disability Insurance Policy
- during the Elimination Period and the next 24 months of Sickness or accidental injury, more than 80% of Your Predisability Earnings at Your Own Occupation from any employer in Your Local Economy; and
- after such period, more than 80% of your Predisability Earnings from any employer in Your Local Economy at any gainful occupation for which You are reasonably qualified taking into account Your training, education, and experience.
Disability claims are frequently denied when the definition of disability changes from “own occupation” to “any occupation”. The differences are technical and confusing, and the insurance company will do its best to confuse claimants.
What To Do After a Claim Denial
If MetLife denied your claim for long term disability benefits, the first thing you must understand is that the decision to deny a disability benefits claim is not final. You have the right to appeal a long term disability denial, and the insurer is supposed to conduct a full and fair review of your claim in a timely manner. Your denial letter will state how long you have to appeal and how to submit your appeal.
Read and Understand Your Denial Letter
It is important that you read your denial letter and fully understand the reason your claim was denied before. Otherwise, you won’t know what medical, financial, or vocational documentation you may need to add to the administrative record on appeal to support your long term disability claim for benefits.
If you’re not sure why your initial claim was denied, our experienced legal team can help you understand the reasoning behind your MetLife disability denial and what medical records or other evidence may have been lacking in your initial application for long term disability benefits.
Appeal Your MetLife Disability Denial
Filing an appeal with the insurance carrier should not be taken lightly. Long term disability lawyers do not just send a brief letter to the insurance companies stating, “We appeal.” We know that is wholly insufficient and would only result in MetLife upholding the decision to deny your claim. You must submit new evidence during the administrative appeals process.
Medical Evidence to Support Your Appeal
Such documentation may include medical evidence from your treating physician, statements from friends and family, and even statement from the claimant themselves. Your appeal to MetLife may include some or all of the following:
- Updated medical records;
- Opinion letters in support of your claim from medical experts;
- Your declaration;
- Declarations from friends, family, and/or co-workers;
- Results from a Functional Capacity Evaluation; and
- Residual Functional Capacity Forms.
At Ortiz Law Firm, we understand how vital these disability insurance benefits are to our clients and how devasting it is to receive a denial. Long term disability attorney, Nick Ortiz, and his experienced legal team help clients with administrative appeals by gathering all of the necessary documentation and preparing appeal letters in a manner that gives his clients the best chance of successfully obtaining benefits from MetLife.
If you are moving forward with the appeal process without an attorney, you must understand the importance of submitting sufficient documentation to support your claim. We also encourage you to review our free disability insurance appeal guide first. You will get a step-by-step guide to the disability insurance appeal process, RFC forms, appeal letter templates, and more.
File a Lawsuit Against Your Insurance Company
If MetLife is still trying to avoid paying your claim and has also denied your administrative appeal, you could have the option to file a second appeal (if your policy allows it) or you may have to resort to filing a lawsuit. Depending on how you obtained your policy, you may have an ERISA disability case, which means a lawsuit would be filed under the Employee Retirement Income Security Act of 1974 (ERISA), which is federal law.
ERISA Claims
If you obtained your policy as part of a group employee benefits plan, it is probably an ERISA policy. Many disability claims are governed by ERISA. In an ERISA disability denial case, a federal judge will review your claim and all of the evidence the company used while deciding if your claim should be denied, then determine whether Met Life’s decision to deny your claim for benefits was proper under the terms of the policy and the law. ERISA law can be extremely complicated and heavily favors the insurance company, so many claimants choose to work with an ERISA attorney that specializes in long term disability.
Non-ERISA Claims
If you did not obtain your policy as part of a group employee benefits plan, you probably have a non-ERISA disability insurance policy. Claimants with non-ERISA policies can still file a lawsuit against their insurance providers for denying their long term disability insurance claim, but it will not be governed by federal ERISA law.
We understand that insurance companies do not always operate in good faith and will fight to protect your rights as a policyholder. We have experience filing suits against MetLife and many other insurance companies. If you are interested in learning more about how we can help, don’t hesitate to contact us.
Hire a MetLife Disability Claim Attorney to Fight For Your Long Term Disability Benefits
We know how critical these benefits are to support you and your family and how difficult it can be to fight for your benefits when you are already dealing with serious physical and/or mental medical conditions. If MetLife has denied your claim, you have the right to fight back – and you do not have to face the insurance company alone. There are experienced disability lawyers who can help you fight your MetLife disability denial.
Nick Ortiz is the founder of the Ortiz Law Firm and an experienced MetLife long term disability insurance attorney who has helped hundreds of claimants obtain their long term disability insurance benefits from MetLife and other major disability insurance companies. We will guide you through the long term disability appeal process and will work diligently to build up evidence that will improve your chances of winning your MetLife disability claim. If you have any questions or concerns during the appeal process with the disability insurance company, our experienced legal team will be standing by to assist you.
If the disability insurance company decides to uphold the decision to deny your long term disability claim, we will assist you in determining the next best step. If necessary, we will file a lawsuit against the insurance company to recover your long term disability benefits. Disability attorney Nick Ortiz is not afraid to take on MetLife or any other insurance company.
Schedule Your Free Case Evaluation to Get Help with Your MetLife Disability Claim
We off a free case evaluation to claimants who have received a long term disability denial or termination letter from MetLife or any of the other major disability insurance companies. During your free consultation, an experienced lawyer will review your MetLife denial letter, evaluate the policy terms and definitions used to deny your claim, and will offer advice as to how you should proceed with your MetLife disability claim.
We would welcome the opportunity to review your disability claim denial and discuss how we can help with your claim. There is no obligation to commit to an attorney-client relationship, but if you do, there are no fees to pay upfront. You only pay an attorney’s fee if we are successful in obtaining your previously denied benefits.
If your MetLife long term disability claim has been wrongfully denied or terminated, call our office at (888) 321-8131 to schedule your free consultation today.