Prudent people avoid foreseeable mistakes and prepare for unavoidable accidents or mishaps. Disability insurance is one of the many ways that prudent people protect themselves from sickness or injury that disables them from their occupation. Disability insurance should protect you in the event that a covered debilitating life event occurs. Insurance companies should step up and treat policyholders in good faith in the aftermath of a disabling event—paying disability insurance benefits for rightful claims without delay or undue burden.
Unfortunately, the truth is that this doesn’t generally happen. Big insurance companies understand they can increase their profits by delaying and denying legitimate disability insurance claims or by giving policyholders the runaround. Unfortunately, insurance companies act unreasonably more often than one might imagine. Common red flags that indicate illegitimate claims delays or denials include:
- Requests for independent medical examinations by unqualified physicians or reviewers
- Massive requests for duplicative documentation
- Failing to make a disability insurance claim decision within a reasonable amount of time
- Minimizing objective and subjective medical evidence supporting disability
Insurers get away with this underhanded behavior when policyholders don’t fight back. By denying disability insurance claims outright or convincing policyholders to settle claims for less money, insurers literally bank on you not putting up much of a fight.
If you believe that Metropolitan Life has wrongfully delayed or denied your disability insurance claim, we can help. In the past, customers have accused Metropolitan Life (MetLife) of:
- Failing to inform claimants about how to perfect their appeal options following denials
- Wrongfully denying or terminating disability insurance benefits by relying on biased doctor reviews
- Failure to pay disability insurance benefits based on the wrong occupational demands
At DarrasLaw, our team of disability insurance attorneys and ERISA includes Frank N. Darras, America’s Top Disability Lawyer. We have the experience and knowledge to fight for the coverage you deserve from MetLife. Contact our law firm today for immediate assistance with your MetLife individual disability or group insurance case.
Who Is MetLife? What Does It Offer?
It is important to understand your insurance company—before, during, and after disability claim issues arise. Generally, it is a good idea to have an understanding of the company, even in the best-case scenarios.
Not every denial is wrongful or subject to criticism. Understanding your insurance company, and the policy that you have, can help you know when to fight back!
MetLife offers both short- and long-term disability insurance benefits. Generally, its short-term disability (STD) policies provide disability insurance benefits for three months to one year—depending on the policy. MetLife’s long-term disability (LTD) policies provide disability insurance benefits for disabilities that leave customers unable to perform their occupational duties after an elimination period for as short as twelve months all the way to normal retirement age.
As with all disability insurance, it is imperative that you—the policyholder—understand your insurer’s definition of disabled. This term may not conform to your typical usage or understanding of the word; the insurer’s definition may involve narrower, more specific meanings that you must show to receive disability insurance benefits.
The definition of disability will vary depending on your plan. Some policies consider you disabled if, due to sickness or accidental injury you’re unable to perform the duties of your own occupation, while others consider you disabled if you’re unable to perform the duties of any occupation taking into consideration your training, education and experience. Other policies provide an initial period of own occupation coverage, then the disability definition switches to the any occupation by which you’re trained, educated, or suited.
As you can see, what you must prove—through medical documentation—to receive disability insurance benefits will largely depend on definitions and how your situation fits them. Make sure you understand the features, advantages, and benefits of your policy so you know how to prepare your claim. If you have questions or just want further clarification, contact DarrasLaw. We are the nation’s top disability insurance litigation firm, and we can help you understand your policy’s language.
MetLife’s Patchy Claims Past
Insurance companies are known to undervalue disability insurance claims or even to deny rightful claims outright. This may happen because disability companies understand some people will not fight back. When policy holders don’t or can’t fight back, insurance companies save money. Insurance companies bank on policyholder decisions to not fight back when their disability insurance claims are denied or delayed.
DarrasLaw is here to help people like you whose disability insurance claims were wrongfully delayed or denied. We can help you fight back. MetLife, along with other insurance companies—are big dogs. We get that. It can feel intimidating to even think about suing a billion dollar insurance company. At DarrasLaw, we have the seasoned, hard-fought experience to make big dogs obey. If your legitimate disability insurance claim was wrongfully delayed or denied, the law is on your side.
Insurance companies are not allowed to get away with unreasonable bad faith denials and they should not get away with simply looking for reasons to deny disability insurance claims.
Often there are certain actions when requested or performed by insurers that are signals that you may need to consult an experienced disability insurance lawyer or ERISA attorney trained to identify wrongful delays or denials. MetLife, as well as most other big insurance companies, have been known to employ a variety of tactics in delaying, denying, and terminating valid disability coverage claims.
Thankfully, some really terrific policyholders fight back. MetLife has been involved in a number of disability insurance denial cases, initiated by policyholders who had enough. The following case is useful to review, not only because of its facts, but also because of the discussion of the courts—including the U.S. Supreme Court; these discussions provide insight into the way various courts view disability insurance claim denial and ERISA disability issues.
Metropolitan Life Insurance Company v. Wanda Glenn
The Employee Retirement Income Security Act of 1974, or ERISA, is a federal law that insurance companies must follow when it applies. Not every group disability insurance policy falls under ERISA, but many do—particularly those insurance plans that are provided by employers. ERISA provides certain minimal protections to these insureds, requiring insurance companies to follow certain procedural guidelines—among other things. In this case, Wanda Glenn challenged MetLife’s discontinuation of her group disability insurance benefits pursuant to an alleged ERISA violation—that the insurance company faced a conflict of interest by both determining eligibility for disability insurance benefits payments and making these same payments.
On appeal, the Sixth Circuit provided useful insights—ruling that a court’s review of a group ERISA disability insurance claims denial must consider whether, and to what extent, an insurer’s conflict of interest may have actually affected its determination of disability insurance benefits.
The pertinent facts were: Glenn, the plaintiff, suffered cardiac arrest. Later, she began working for Sears. After working at Sears for roughly a year, she was diagnosed with an “enlarged and weakened heart.” Due to the severity of her condition, she was referred to a specialist, who was to determine whether she needed a heart transplant.