In need of a MetLife disability denial lawyer? Lawyers at Marc Whitehead & Associates are ready and able to stand up for your rights in the appeal process. It is unfortunately common practice for insurers like MetLife to deny valid claims as a way to increase their profits. A MetLife disability claims lawyer at Marc Whitehead & Associates is ready and able to stand up for your rights in the appeal process. Make sure you get the full benefit that you rightly deserve. Call us today to discuss your case with a friendly, knowledgeable attorney!
Founded in 1863, Metropolitan Life Insurance Company (MetLife) is the third-largest life insurer in America, holding 6.05% market share. You may have a group long-term disability plan through your employer, or you may have had the foresight to buy a Long-Term Disability (LTD) insurance policy to replace your wages if you ever became disabled due to illness or injury. Yet, there’s no guarantee you’ll receive a monthly check as promised. You may need the assistance of a long-term disability lawyer to reach a fair claim resolution.
Litigation Against MetLife
MetLife is no stranger to litigation involving claimants suing over wrongful denials. Before it gets to that point, having an experienced short-or-long-term disability lawyer represent you can make all the difference in the appeals process. The insurer may grant benefits based on your attorney’s arguments and evidence.
However, there are times when MetLife will not grant benefits despite solid evidence that the claim is valid. That is typical of many large insurance companies. The insurer saves money while a disabled person suffers the consequences. Under these circumstances, litigation is the only way for a claimant to receive justice.
Under the federal Employee Retirement Income Security Act of 1974 (ERISA), employees can file an appeal with their insurer if they are denied short- or long-term disability benefits. If the appeal is denied, a disability attorney can file a federal lawsuit against the insurance plan provider.
Metropolitan Life Insurance Company vs. Glenn
One of the best-known cases involves Metropolitan Life Insurance Company vs. Glenn. Long-time Sears employee Wanda Glenn was a sales manager in the women’s department. She was covered by Sears’ long-term disability plan, administered by MetLife. After being diagnosed with a serious heart condition, which at one point included a discussion regarding a heart transplant with her cardiologist, Glenn took medical leave from her employer and submitted a disability claim as per ERISA.
MetLife approved her claim and instructed Glenn to take Social Security payments. Those payments would be deducted from her MetLife payments. Later, an administrative law judge determined that Glenn was disabled, based on information MetLife provided, and indeed eligible for Social Security. MetLife then changed its determination, alleging Glenn was not eligible for disability benefits and could work.
Glenn filed a lawsuit in district court, which decided in favor of MetLife. However, the U.S. Sixth Court of Appeals reversed this decision.
The appellate court noted that Sear’s description of Glenn’s job required:
- Sitting up to 20 percent of the workday.
- Standing for 20-60 percent of the workday.
- Some climbing, reaching, stooping, and lifting.
The court decided there was a conflict of interest, as MetLife determines whether an employee is eligible for benefits and whether to pay those benefits.
The Glenn case also illustrates many common complaints against MetLife. Like others who thought they could rely on MetLife disability benefits, she discovered the insurer terminated disability benefits based on in-house medical file reviews.
MetLife never had a doctor physically examine Glenn. Instead, its decision to terminate her benefits was based on the opinion of an in-house physician who had just looked at the file. Glenn also had to deal with the insurance giant using the wrong vocational criteria when it issued its denial.
Other allegations frequently made against MetLife by those denied benefits include:
- Not informing claimants about appeal options.
- Ignoring objective evidence of disability.
- Not paying benefits based on incorrect occupational demands.
Although most claims are settled, at Marc Whitehead & Associates, we will litigate a MetLife disability claim denial or appeal.
How Does the MetLife Long-Term Care Claims Process Work?
Unfortunately, simply having a policy is not enough. You will need to file an application for benefits and MetLife will have to decide whether you qualify. You must provide all necessary documentation and comply with the terms of the policy in order to make a valid claim.
There are two important points to keep in mind:
- MetLife may have little incentive to provide decent service.
If you purchased your own policy once upon a time, you might be surprised to learn the company suspended the sale of new individual disability insurance policies in 2016, pivoting the business toward products they see as more profitable. While MetLife vowed to continue serving existing policies, they have less incentive to provide superior customer service if they’re no longer selling in this market.
- Like all insurance companies in America, they are a for-profit business, first and foremost.
Even though you or your employer have been paying premiums, every long-term disability payout represents a potential “business loss” for the insurance company, so they try to maximize money flowing in by raising premiums and minimize money flowing out by denying claims.
Why Are MetLife Disability Claims Denied?
The reasons that MetLife gives for denying a claim may not be justified. Reasons they may give you for long-term disability claim denials include:
- You do not meet “the definition of disability” under the terms of the policy.
- Your disability was caused by an excluded pre-existing condition.
- The insurer did not receive all required medical records.
- There is “insufficient evidence” of disability.
- You self-reported symptoms, rather than seeking “appropriate care.”
- The insurance company’s doctors disagree with your physician.
- You were caught performing physical activities a disability should have prevented you from doing.
While these can be legitimate reasons for refusing to pay a claim, a denial letter isn’t the last word. You still have options for dispute and resolution, which may result in a reversal with full benefits and back pay.
How to Appeal Denied MetLife Disability Insurance Claims
When appealing a denial, it helps to have a seasoned disability lawyer look over your policy to determine whether you’ve met all criteria to satisfy the terms and conditions.
An attorney can also see that the denial letter provides an appropriate explanation, including:
- The main reasons your claim was denied
- A summary of the evidence used to deny your claim
- The name and title of the person reviewing the claim
- An explanation of what medical evidence is necessary to approve the claim
- Information about your right to appeal the decision, along with a deadline
MetLife disability insurance claims may require:
- Collection of updated medical records
- Procurement of new opinion letters from your treating physicians
- Your declaration that you have submitted truthful and accurate information
- Supporting declarations from friends, family, and/or coworkers
- An independent medical evaluation and functional capacity testing
If your appeal is denied, you may then have the option to file a secondary appeal or file a lawsuit. If you obtain insurance through your employer, you may be able to file a lawsuit under the Employee Retirement Income Security Act of 1974 (ERISA), which will be determined by a federal judge.
Get Help from a MetLife Disability Denial Lawyer Nationwide
All too often, perfectly valid MetLife disability claims are denied, prompting policyholders to seek the assistance of disability lawyers in appealing the decision. While a MetLife short-term disability claim can be stressful as you wonder how you’ll cover vital living expenses as you are off work recovering, a long-term disability claim is even more worrisome as you’ll need to consider how to support your family well into the future without regular wages.
The sooner you call a long-term disability attorney, the better, as there are strict time limits for pursuing a claim. In most cases, you will only have 180 days from the day you receive a claim denial letter to file a notice of appeal. You needn’t wait for a denial to begin working with a professional who knows the ropes. Call Marc Whitehead & Associates for help getting the benefits you deserve.
