Founded in 1863, Metropolitan Life Insurance Company (MetLife for short) is one of the most well-recognized insurance companies offering coverage across the United States. MetLife is also one of the largest life insurance companies in North America. MetLife offers a wide variety of insurance policies, including contracts for short term disability and long term disability benefits. MetLife sells group disability insurance protection to employees as “fringe benefits” through employers and sells individual disability policies directly to individuals looking to protect themselves. Unfortunately, many disability claims result in MetLife disability denials instead of a monthly disability benefit.
Claims Are Denied By MetLife Insurance Company
You may be one of the few who had the foresight to actually purchase a Long Term Disability (LTD) insurance policy to replace your wages in the event that you became unable to work due to an injury or disability. MetLife’s long term disability coverage is intended to provide such financial support. Unfortunately, having a long term disability insurance policy is not enough. You must still file an application for benefits with MetLife, and the insurance company evaluates your claim to determine if you qualify for benefits under your LTD Plan.
Yes. You read that right. MetLife is the one who reviews your claim to determine whether it must pay you benefits under the policy. Most of us consider that a conflict of interest. It is troubling to think that although you had to stop working due to a severe injury or illness, MetLife could still deny your claim. Insurance companies are businesses after all, and every disability claim paid reduces an insurance companies’ profits. Fortunately, if MetLife denied your claim, you can retain a disability attorney to give legal advice and represent you in the appeal process.
Insurance Companies Wrongfully Deny Claims
In other words, although you may qualify for disability benefits, that does not necessarily mean that MetLife will approve your disability claim. Many individuals who become disabled meet all the requirements to receive long term disability insurance benefits but still receive a disability denial letter. Others are cut off from their benefits after having received long term disability benefits for a period of time, even though they may not be able to return to work. The insurance company is more interested in saving money than paying disability benefits. In short, MetLife wrongfully denies long term disability benefits for many disabled claimants.
If your LTD claim has been wrongfully denied or your claim was terminated before you are able to return to work, you should seriously consider hiring a MetLife disability lawyer to help you appeal the claim denial. At the Ortiz Law Firm, our experienced disability lawyers and other legal professionals understand how critical short term and long term disability benefits can be to you and your family. You need these benefits to replace your lost income while you are unable to work. We also understand how difficult it can be to fight for your denied benefits when you are already dealing with serious physical and/or mental medical conditions.
Even if MetLife denied your claim, you do not have to face MetLife and the appeal process alone. Nick Ortiz is a MetLife disability attorney with the knowledge and experience to help you navigate the administrative appeal process. If you have exhausted your administrative appeals with the insurance company, our firm can assist you in preparing and filing a lawsuit again the disability insurance company.
Reasons for MetLife Disability Denials
It is important to understand the reason why MetLife denied your claim for benefits so that you know what to dispute and what medical evidence is needed when you submit your appeal to your insurance carrier. There are multiple reasons MetLife could cite when explaining why your claim for benefits was denied. Here are some of the most common reasons MetLife has used to justify its decision to issue a claim denial. The quotes below are sourced from real claim denials and policies.
You Do Not Meet the Definition of Disability
This is one of the most common and most general reasons a claim for disability benefits will be denied. Your denial letter might state:
Our information indicates that you do not meet the medical requirements as described in the Plan. The Plan states, “Disabled or Disability means that, due to Sickness or as a 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 more than 80% of your Predisability Earnings at your Own Occupation for Any employer.”‘
Own Occupation vs. Any Occupation
Some policies have a definition of disability that changes after a certain period of time, typically 24-months. Claims are frequently terminated after a change in definition occurs. Here is an example of one such policy:
Disabled of Disability means that, due to Sickness of accidental injury:
You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment, and You are unable to earn:
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 60% 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.
Appealing a Denied Disability Claim
If you have received a denial letter from MetLife or another disability insurance company, the first thing you must understand is that the decision to deny your claim is not final. You have the right to appeal a denied long term disability claim. Mr. Ortiz can help you understand the reasoning behind your disability claim denial and what may have been lacking in your initial application for long term disability benefits.
Filing an appeal with the insurance company should not be taken lightly. Once retained, Mr. Ortiz does not just send brief letters to the insurance companies simply stating, “We appeal.” We know that is wholly insufficient. With his years of experience handling long term disability claim denials, Mr. Ortiz is familiar with the additional medical and opinion evidence you should submit with your appeal to MetLife’s disability Insurance claim department. Such information may include evidence from doctors, friends and family, and clients themselves. Your appeal to MetLife may consist of all or some of the following:
- Updated medical records;
- Opinion letters in support of your claim from your doctors;
- Your declaration;
- Declarations from friends, family, and/or co-workers;
- Independent medical evaluations; and
- Residual Functional Capacity Forms.
If MetLife has denied your disability claim we can help. Mr. Ortiz and his legal team help clients gather and organize all of the required information and documentation, and help clients prepare the appeal in a manner that gives his clients the best chance of successfully obtaining benefits. We understand how vital these disability insurance benefits are to our clients.
Should the appeal with MetLife also be denied, you may have the option to either file a second appeal (if your policy allows it) or file 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. In an ERISA disability case, a federal judge will review your claim and all of the evidence the company used while deciding if your claim should be denied, and make a determination as to whether Met Life’s decision to deny your claim for benefits was proper under the terms of the policy and under the law.
Hire a MetLife Long Term Disability Claim Attorney
Mr. Ortiz is the founder of the Ortiz Law Firm and an experienced disability insurance attorney. Mr. Ortiz has successfully represented many MetLife long term disability insurance policyholders in their fight to obtain their MetLife disability insurance benefits. We work with clients after a long term disability insurance claim denial has been issued by an insurance company.
Mr. Ortiz is an experienced LTD disability benefits attorney and will work with you through each step in the appeals process. Mr. Ortiz has handled insurance claims with all of the major insurance companies, including numerous MetLife long term disability appeals, and will use this experience to work with you to build the evidence that will be critical to improving the chances of winning your MetLife disability case.
Although most insurance companies give you 180 days from the date you receive the denial letter to appeal the denial, we need as much time as possible to develop the best evidence for your appeal. That’s why it is so important to contact us as soon as you receive your denial letter from MetLife.
Free Case Evaluation with a Disability Attorney
If you are a MetLife long term disability policyholder and your disability claim has been wrongfully denied or terminated, contact our office online or call (866) 853-7703 to request a free case evaluation. Free consultations are available to claimants who have received a denial or termination letter from the insurance company. An attorney will review your MetLife denial letter, evaluate the definition of disability MetLife used to evaluate your disability claim and offer legal advice as to how you should proceed with your MetLife disability claim. If you decide to hire our law firm, there are no fees to pay upfront.