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MetLife Long-Term Disability Denial: How to Appeal

Metropolitan Life Insurance Company, better known as MetLife, is one of the largest insurance companies in the world.  Officially founded in 1868, it roots began with its 1863 predecessor, National Union Life and Limb Insurance Company, which provided insurance to Civil War soldiers for disabilities due to wounds and illness caused by war.  In 1868, the company became MetLife and now provides insurance, annuities, and employee benefits to 90 million customers in over 60 countries.  Today, if you are insured by a MetLife long-term disability plan, you can get up to 60 percent of your work earnings covered by insurance payments, but the process for acquiring these benefits is not always easy.

While MetLife has come to be associated with amicable blimps touting its name at sporting games, successfully filing a long-term disability insurance claim can be difficult for claimants.   Insurance companies like MetLife will sometimes prioritize their business over the needs of the insured by making their policies extensive and difficult to satisfy.  This can result in wrongful claim denial.  Fortunately, the appeal process can provide another chance for your claim to be approved if you take the right steps.

If you have filed for long-term disability benefits with MetLife and have been denied, or were previously receiving benefits before they were wrongfully terminated, there are actions you can take in the appeal process to strengthen your claim.  While you can handle your appeal yourself, it can benefit you to seek the help of a long-term disability attorney, as appeals are often the last chance you have to get strong evidence onto your record before it closes.  The long-term disability lawyers at CCK have experience in handling appeals with MetLife, and you can call 800-544-9144 today for a free consultation.

Reasons MetLife May Have Denied Your Claim

If you are denied disability benefits, you will likely receive a letter by mail from MetLife notifying you.  You will want to read this letter over carefully, as it will likely contain information about why your initial claim was denied, or if you were previously approved, why your benefits have been terminated.  Your denial letter should also contain instructions on how to move forward with an appeal.

There are, unfortunately, numerous reasons an insurance company such as MetLife might deny your claim.  Many reasons are valid; your claim may lack sufficient evidence or not meet all the policy requirements.  There are also ways insurance companies can make it tricky for claimants to get approved.  Your policy may be one that is particularly difficult to fulfill because its definition of disability is limiting, depending on your plan.  Insurance companies are known to keep surveillance on claimants, or purposefully issue repeated demands and make the process confusing or inconvenient.

Reasons your claim might have been denied by MetLife include:

  • Failure to meet your policy’s definition of disability: It is imperative to the success of your claim that you satisfy its definition of disability.  This can, however, be more difficult than it seems, especially when companies like MetLife include very specific, sometimes confusing, requirements, or have plans that can be limiting and exclude certain types of disabilities.  When filing an appeal, you should ensure you fully understand the definition and gather the necessary evidence to satisfy it.
  • Missed deadlines: Deadlines for the long-term disability appeal process can be strict.  Missing a deadline can result in a denial or loss of rights to long-term disability benefits altogether.  During the appeal process, you will want to keep close track of your deadlines to make sure that all evidence, forms, and documentation are submitted on time.
  • Weak evidence: You will need to submit medical evidence to support your disability claim.  MetLife may deny your claim on the grounds that your evidence did not satisfy the definition of disability in your policy.  As part of your appeal, you may want to seek further examinations and speak with other medical or vocational professionals to obtain stronger or additional evidence that proves your disabling medical condition.
  • Video and social media surveillance: It is within the rights of MetLife and other insurance companies to hire investigators to keep surveillance on you with the intention of catching something that might disprove your claim.  For instance, you may unintentionally generalize your condition and tell your doctor that you are never able to lift over five pounds.  However, if video surveillance catches you lifting a bag of groceries, or you are pictured on social media holding a baby, MetLife can use this as grounds to deny your claim.  Therefore, it is important to be completely aware about the limitations of your medical condition and honest with your doctor about them. Insurance companies will take your evidence very literally and use any discrepancy they can catch to deny your claim.

What you Need to Appeal a Denied MetLife Long-Term Disability Claim

In moving forward with an appeal for long-term disability benefits, you will likely want to procure additional evidence that strengthens weaker areas of your claim.  You may also want to strengthen existing evidence.  It is critical you submit firm evidence during your appeal because is likely that no further evidence will be accepted beyond this stage, especially in ERISA-governed cases.  In court, your case will be based on the evidence you submitted for your appeal.

You should consult your denial letter for specific reasons as to why your claim was denied or terminated.  By strengthening these specific areas of your claim, MetLife will have less of a case to deny you again.  Additional steps that can be taken in your appeal for a denied long-term disability claim from MetLife include:

  • Correct errors in your initial claim: If you were denied because your initial application was not completed correctly or was missing information, the appeal can be your chance to correct it. Make sure that you read your policy carefully before you amend it, so that you can ensure you are submitting the right information in the manner they require.
  • Request a report by your treating physician: A written report by your physician can back up your existing medical records, since medical records do not always document the full extent of your disabling condition. Your physician may be able to specify how certain symptoms affect you in a more in-depth way than a simple diagnosis.  It is important that you are honest with your doctor about your condition so that everything can be taken into account.
  • Impact statements from personal acquaintances: Family, friends, and coworkers have likely taken notice of your how medical condition affects your personal and daily life. Written testimonies from such acquaintances detailing how they have witnessed the ways your disability impairs you, both at home and at work, can be strong pieces of evidence to include in your appeal.
  • Expert opinions: As part of their assessment of your claim, MetLife might hire their own vocational or medical experts to investigate your claim.  This can be dangerous for your claim, especially since experts hired by insurance companies tend to be biased toward the insurance company.  To refute this, you may want to seek out the opinions of unbiased experts who can do their own assessment of your occupation or perform additional medical exams.  The results of their assessments may be able to strengthen your claim.

How Chisholm Chisholm & Kilpatrick Can Help You with Your Appeal

While you can handle your appeal on your own, it can be critical during the appeal stage of the long-term disability process to seek an attorney.  If your appeal is denied and you must take your case to court, you likely will not be allowed to present new evidence.  The legal team at Chisholm Chisholm & Kilpatrick LTD has experience handling appeals against MetLife, and the expertise to ensure your claim is approved before it can be taken to court.

Our attorneys will carefully examine your policy and denial letter to ensure all guidelines are followed and all requirements are satisfied.  We understand that companies that might not always operate in good faith, and know how to catch errors or wrongdoings that can compromise your claim.  Our legal team can advise you on the type of evidence that can help your claim, as well as serve as a point of communication between yourself and doctors or vocational experts.  CCK understands that focusing on your health can be stressful enough on its own without the added burden of filing a long-term disability appeal.  You can take care of your medical condition as our legal team takes care of your claim.

Contact Chisholm Chisholm & Kilpatrick LTD Today

The long-term disability attorneys at CCK have over 33 years of collective experience assisting claimants with appeals against MetLife and insurance companies like it.  With our knowledge of long-term disability practices and ERISA laws, we are prepared to fight for your claim.

Chisholm Chisholm & Kilpatrick is ready to assist you with your appeal.  If you have a disabling condition and are unable to work, you can contact a member of our team at 800-544-9144 today for a free consultation.

Long-term Disability Claims Process Overview