Metropolitan Life Insurance Company—more commonly known as MetLife—is one of the world’s largest financial services companies. While MetLife is typically associated with life insurance and financial services, the company has a robust disability insurance business as well.
If you’ve recently had a long-term disability claim denied by MetLife, we understand how frustrated you might feel. Before you give up and accept MetLife’s decision, you should consult with a disability insurance lawyer at Bryant Legal Group. We have extensive experience with MetLife disability insurance appeals and can help you understand your legal options. Keep reading to learn essential steps you should take after a disability insurance denial.
MetLife Has a Track Record of Denying Valid Claims
While many of us associate MetLife with friendly images of blimps at sporting events and advertising with cartoon characters, it is a hard-nosed, savvy company. It has sometimes run afoul of state insurance regulators.
MetLife has a history of mishandling claims and even losing them. In January of 2019, New York regulators fined MetLife $19.75 million for mishandling and misplacing thousands of its clients’ pension claims. It had to pay hundreds of millions to clients whose claims were lost, delayed, or otherwise mishandled.
For large companies like MetLife, their primary goal is profit. They process thousands of claims and cutting corners is more common than any of us want to admit. However, there are ways you can protect yourself and improve your likelihood of getting the disability benefits you deserve.
RELATED ARTICLE: When Should I Speak With a Disability Lawyer?
Most MetLife Disability Insurance Plans Are Governed by ERISA
Unlike many other large insurance companies, MetLife currently doesn’t sell individual disability insurance policies to private individuals. Since September 2016, MetLife has only offered group disability coverage through employee benefit programs.
That means if you have disability insurance through MetLife, your plan is almost certainly governed by a federal law known as the Employee Retirement Income Security Act of 1974, or ERISA for short. You have certain rights and protections under ERISA. However, you also must follow strict guidelines for how and when you can appeal a disability denial or file a lawsuit, and what evidence you’re allowed to include.
The remainder of this blog post will primarily focus on the MetLife appeals process under ERISA.
If you did purchase an individual disability insurance policy directly from MetLife (not through an employer) before September 2016, and that policy remains in force, a different set of rules may apply to you. We will touch on this briefly toward the end of this article.
A Step-By-Step Look at the MetLife Long-Term Disability Appeals Process
You must act quickly once your claim has been denied. Under ERISA, you only have a limited time to appeal, and you want to make sure that initial appeal is as comprehensive as possible. You might only get one chance to add evidence to the record.
Read Your Denial Letter Carefully
MetLife is legally required to provide two critical pieces of information in their denial letter:
- The specific reason they denied your claim. For example, they might say you didn’t provide enough evidence, your condition isn’t covered, or they do not believe you meet the plan’s definition of disability.
- Their appeal procedures and guidelines. Each disability insurance company has its own administrative appeals process, and under ERISA you must appeal directly to MetLife before you can file a lawsuit in court. You also will have a maximum of 180 days to file an appeal. That might sound like a lot, but it isn’t.
Request a Copy of Your Claims File
MetLife may have provided this with your denial letter—but if they didn’t, request it immediately. Your claims file should include all the information that MetLife used to make their determination. This could include medical records, job descriptions, and other evidence.
By reviewing your denial letter, your claims file, and your plan documents, you can get a much better sense of whether MetLife’s denial was legitimate—and if not, the additional evidence you’ll need to provide for your appeal to be successful.
Contact a Long-Term Disability Lawyer
ERISA appeals are extremely risky to try to tackle on your own. The stakes are high and mistakes can be costly.
The denial letter might make it seem like MetLife’s appeals process is simple and straightforward. It isn’t. More likely than not, you will need to present extensive evidence and arguments in an organized way.
You do not want to mess this up, and building a successful appeal will take time even for an experienced attorney. The sooner you get a professional to review your case, the better your chances of success.
Gather the Necessary Evidence
Once your attorney reviews the denial letter, plan documents, and claims file—and determines you have a good case—they will start to help you gather the relevant evidence. This might include things like:
- Additional medical records
- Functional evaluations that measure your physical and cognitive performance
- Vocational evaluations of your realistic future employability and earning capacity
- Letters of support from doctors and medical staff
- Letters of support from colleagues, family members, and other individuals who are knowledgeable about your physical and mental capabilities, before and after you became disabled
- Photos, videos, journal entries, and other recordings of your daily experiences and circumstances
- Any other evidence your long-term disability lawyer might consider relevant to your case
Make Sure Your Evidentiary Record Is Complete
In an ERISA claim, you only have a limited amount of time to submit evidence. Once MetLife reviews your appeal and makes its final decision, you cannot submit additional information, no matter how important it is to your case. Even if MetLife denies your appeal, and you file a lawsuit, the court will only be able to review the evidence that is already in the claims file.
Unfortunately, many people make the mistake of submitting an appeal without additional evidence. Your lawyer can help you collect and submit evidence that supports your allegations and documents your disabilities.
RELATED: ERISA Claims and Exhausting Administrative Remedies: What You Need to Know – Bryant Legal Group (bryantlg.com)
File Your Administrative Appeal and Wait for a Response
Once you have your evidence together, your attorney will help you prepare and submit your appeal. This will include all the new evidence you’re adding to the claims file. It will also include a detailed appeal letter that outlines why, specifically, you disagree with MetLife’s determination and believe your benefits should be approved.
After you appeal, MetLife will have an initial deadline of 45 days to respond. This can be extended one time for an additional 45 days, so you could be waiting almost three months to find out if your appeal has been accepted.
Consider Legal Action If Your Appeal Is Denied
If your claim is denied, and there are no more mandatory administrative appeals you must go through, your final option is to file a lawsuit in court.
From here, your case will likely be reviewed by a judge (not a jury) and, as noted above, the judge will only be able to review the existing evidence in your claims file.
Even though no new evidence can be added, your long-term disability lawyer will still be able to represent your interests in court. They can prepare written briefs, present oral arguments, and explain and interpret evidence in the record.
What If I Have an Individual Disability Insurance Plan?
Although MetLife no longer sells individual disability insurance policies to private individuals, they still administer policies that were sold previously. If you have one of these “grandfathered” policies, it may be governed by your state’s contract laws rather than ERISA.
In general, policyholders with non-ERISA plans have more options when it comes to appeals. For example, you may not be required to complete an administrative review before filing a lawsuit, and you may be able to request a full jury trial.
Because each state has a unique set of contract laws, be sure to contact a long-term disability lawyer in your state as soon as possible to begin reviewing your legal options.
RELATED POST: Appealing Denied Private Disability Insurance Claims – Bryant Legal Group (bryantlg.com)
Bryant Legal Group: Disability Lawyers Who Can Fight for Your Rights
If MetLife recently denied your disability claim, it’s in your best interest to consult with a skilled lawyer at Bryant Legal Group. We are proud to help our clients assess their legal options, identify the correct procedures, “stack” their evidentiary record, and negotiate with the long-term disability company.
To learn more about our approach and how we might be able to help you, please contact us today to receive a free and confidential consultation. You can reach Bryant Legal Group by calling 312-561-3010 or completing this brief online form.
