Using Professionals to Defend Against Metlife Disability Appeals
Obtaining long-term disability benefits can be complicated and full of obstacles. This is especially true when dealing with large insurance companies like MetLife, also known as Metropolitan Life Insurance Company. One of the biggest insurance providers in the world, MetLife offers employee benefits, annuities, and insurance to millions of clients worldwide. It can be difficult to submit a long-term disability insurance claim to MetLife, though. Understanding the MetLife Disability Appeal procedure is crucial if your disability claim has been rejected or prematurely terminated. Despite the company’s friendly image, claimants often find the process of filing a long-term disability insurance claim with MetLife to be difficult and, at times, frustrating.
About MetLife
Founded in 1868, MetLife has a long history of providing insurance services. Initially established to provide insurance to Civil War soldiers for disabilities due to war-inflicted wounds and illnesses, the company has since expanded its services significantly. Today, MetLife offers long-term disability plans that cover up to 60 percent of a policyholder’s work earnings. However, securing these benefits is not always straightforward.
Understanding MetLife LTD Policies
MetLife long-term disability insurance typically includes:
- Definition of Disability: “Own occupation” for the first 24 months, transitioning to “any occupation” thereafter.
- Elimination Period: Usually 90 to 180 days before benefits begin.
- Pre-Existing Condition Clause: Often excludes coverage for conditions treated within 3–12 months prior to the policy’s effective date.
- ERISA Governing Law: Most group policies are subject to ERISA, limiting the ability to present new evidence if the case goes to court.
Tip: Always request a full copy of your policy and Summary Plan Description (SPD) after a denial.
Understanding Disability Denials by MetLife
If you’ve filed for long-term disability benefits with MetLife and have been denied, or if your previously approved benefits have been terminated, it’s essential to understand why this might have happened. MetLife, like many insurance companies, can prioritize their business interests over the needs of the insured, making their policies extensive and challenging to satisfy. This can result in wrongful claim denial. However, the appeal process can provide another opportunity for your claim to be approved if you take the right steps.
There are numerous reasons why MetLife might deny your claim. Some of these reasons may be valid, such as a lack of sufficient evidence or failure to meet all the policy requirements. However, insurance companies can also make the approval process tricky for claimants. For instance, your policy may have a particularly limiting definition of disability, or MetLife may keep surveillance on claimants, or purposefully issue repeated demands to make the process confusing or inconvenient.
The Appeal Process
If your disability benefits have been denied or terminated, you will likely receive a letter from MetLife notifying you of this decision. This letter is crucial as it contains information about why your claim was denied or terminated and provides instructions on how to proceed with an appeal.
The appeal process involves strengthening the weaker areas of your claim and providing additional evidence to support your case. It’s important to note that the appeal stage is often the last chance you have to get strong evidence onto your record before it closes. Therefore, it’s critical to submit compelling evidence during your appeal, especially in cases governed by the Employee Retirement Income Security Act (ERISA). If your appeal is denied and you must take your case to court, you will likely not be allowed to present new evidence. Therefore, the appeal stage is a critical juncture in a MetLife Disability Appeal.
Strengthening Your Appeal
To strengthen your appeal, you should first correct any errors in your initial claim. This could include providing any missing documentation or clarifying any misunderstandings. Next, consider requesting a detailed report from your treating physician that clearly outlines your disability and how it impacts your ability to work. This report can serve as a powerful piece of evidence in your appeal. Here are a few ways to defend your case with MetLife:
- Thoroughly review your policy and understand your rights
- Document all communication and interactions with MetLife
- Seek legal advice if MetLife denies your claim unfairly
- Gather medical evidence and supporting documentation
- Present a clear and comprehensive case during appeals or legal proceedings
In addition to medical evidence, consider gathering impact statements from personal acquaintances, such as friends, family, or co-workers. These statements can provide a firsthand account of how your disability affects your daily life. Lastly, expert opinions from vocational professionals can help to strengthen your claim by providing an objective assessment of your ability to work.
Case Summary: MetLife Denial Reversed for IT Professional with Mental Illness
MetLife wrongfully terminated and denied our client’s claims for disability benefits on the misinformed, unfounded, and false assertion that he is not disabled in accordance with the terms of the disability policies. Our client and his physicians, conclusively demonstrated that his ongoing and severe symptoms stemming from diagnoses of depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD) rendered him incapable of reliably performing his job/occupational duties as a Digital Sales Consultant.
Read Full Case Summary Here...
MetLife wrongfully terminated and denied our client’s claims for disability benefits on the misinformed, unfounded, and false assertion that he is not disabled in accordance with the terms of the disability policies. Our client and his physicians, conclusively demonstrated that his ongoing and severe symptoms stemming from diagnoses of depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD) rendered him incapable of reliably performing his job/occupational duties as a Digital Sales Consultant.
Our client, a former Digital Sales Consultant for News Corp, was forced to cease working in his job/occupation on March 31, 2023, due to debilitating symptoms stemming from depression, anxiety, bipolar disorder, and PTSD. His decision to discontinue his employment was not a matter of choice but rather a response to his deteriorating mental health. His symptoms include difficulty focusing and concentrating, insomnia, lack of motivation, and persistent thoughts of suicide. Furthermore, he has been grappling with unresolved grief following the passing of his mother, for whom he served as the primary caretaker. These overwhelming challenges have significantly impaired his ability to function in a work environment. Furthermore, working in a high-stress environment, where meeting telephone sales quotas was a constant demand, only exacerbated Mr. Hosseini's symptoms. The pressure and demands of his job further contributed to his declining mental health, ultimately leading to his decision to cease working and pursue disability income benefits under his policies with MetLife.
There was no valid basis or reasonable justification for these denials, especially considering the consistent medical evidence, including the opinion of our client’s treating psychiatrist, which supported the severity of his impairments. It's important to highlight that MetLife initially recognized the seriousness of his condition by approving his Short-Term Disability (STD) benefits from his onset of disability on March 31, 2023, through July 31, 2023. Given the absence of any noticeable improvement in his condition since then, there is no reasonable rationale for MetLife's subsequent refusal to extend benefits beyond July 31, 2023 or for its denial of his IDI and LTD benefits. Legal precedent has firmly established that denial/termination of benefits requires a compelling rationale extending beyond mere assertion, especially after benefits have been granted. For example, if benefits are terminated due to demonstrated improvement, the medical evidence should reasonably reflect such substantial progress (Saffon, 522 F.3d at 87). Our client’s medical records do not indicate any significant change in his condition since he was first deemed disabled by MetLife, providing no basis for MetLife's subsequent decisions suggesting his ability to return to work in his occupation as of August 1, 2023. On the contrary, they demonstrate a worsening and ongoing deterioration in his condition, resulting in increased functional impairment. MetLife accused our client of working in his family’s smoothie shop and therefore he was no longer disabled. They obtained surveillance showing his speaking to customers, when in fact he was just being watched by his family who were afraid to leave him alone at home as he had threatened to take his own life. We obtained an affidavit from his family member stating he was never working at the store nor was he capable of doing so. With the help of his treating physicians, we were able to get MetLife to overturn the denial and he remains on claim today.
Understanding MetLife LTD Policies
MetLife long-term disability insurance typically includes:
- Definition of Disability: “Own occupation” for the first 24 months, transitioning to “any occupation” thereafter.
- Elimination Period: Usually 90 to 180 days before benefits begin.
- Pre-Existing Condition Clause: Often excludes coverage for conditions treated within 3–12 months prior to the policy’s effective date.
- ERISA Governing Law: Most group policies are subject to ERISA, limiting the ability to present new evidence if the case goes to court.
Tip: Always request a full copy of your policy and Summary Plan Description (SPD) after a denial.
Professionals Dealing with MetLife Disability Appeals
In essence, handling a MetLife Disability Appeal can be a daunting expedition. It requires a profound understanding of the reasons behind claim denials, coupled with an intimate knowledge of the appeal procedures. While this might seem like an uphill battle to face alone, with tailored guidance and robust support, you can successfully overturn a denial and seize the benefits you are rightfully owed.
Always seek the assistance of a MetLife Insurance Disability Attorney who can steer you through this complex terrain and fervently advocate for your rights. It’s important to remember that denial is merely a hurdle, not the finish line. With relentless determination, a calculated approach, and expert assistance, you can rise to this challenge and secure the benefits you deserve.
About DarrasLaw
Founded by Frank N. Darras, DarrasLaw is the nation’s top disability law firm. We’ve:
- Recovered nearly $1 billion for policyholders
- Reviewed over 100,000 disability claims
- Represented clients in all 50 states
- Handled claims with MetLife, Unum, Prudential, The Standard, and Cigna
Headquartered in Ontario, California, we blend deep expertise with fierce client advocacy—because when your benefits are denied, your livelihood is on the line. DarrasLaw is America’s most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long-term disability and long-term care cases than any other lawyer in the United States. Contact DarrasLaw today.
Disclaimer: This page is for informational purposes only and does not constitute legal advice. Every claim is unique. Prior outcomes do not guarantee future results. For advice specific to your situation, consult with a licensed attorney.
Frequently Asked Questions (FAQs)
How long do I have to appeal a MetLife disability denial?
Under federal ERISA law, you generally have exactly 180 days from the date on your denial letter to file a formal administrative appeal. Missing this deadline by even one day can result in the permanent loss of your right to benefits. Because gathering medical and vocational evidence takes time, it is vital to contact a lawyer as soon as you receive your letter.
Can I submit more than one appeal to MetLife?
Most MetLife group policies require at least one mandatory administrative appeal before you can file a lawsuit. Some policies allow for a second, voluntary appeal. However, you must be careful: if your first appeal was strong, a second voluntary appeal might just be a delay tactic by MetLife. We analyze your specific plan to decide if a second appeal is a strategic benefit or a waste of time.
What is the "Administrative Record" in a MetLife appeal?
The Administrative Record is the total collection of evidence MetLife had when they made their final denial. In ERISA cases, a judge is usually not allowed to look at new evidence once the appeal is over. This means your appeal is your one and only chance to "load the record" with every medical test, expert opinion, and witness statement needed to win.
Will MetLife provide a copy of my claim file for free?
Yes. Under ERISA, MetLife is required to provide you with a complete copy of your claim file (also called the administrative record) free of charge upon request. This file contains internal notes, doctor's reports, and surveillance logs that reveal the real reason they denied you. We use this file to dismantle MetLife’s arguments piece by piece.
How does MetLife use "Peer Review" doctors during the appeal?
MetLife often pays third-party vendors to hire doctors who will review your medical records without ever seeing you in person. These "peer reviewers" frequently ignore your treating physician's restrictions. We challenge these biased reviews by cross-referencing the reviewer's history of always siding with insurance companies and by obtaining rebuttal statements from your own doctors.
Should I use MetLife’s own "Appeal Form"?
MetLife may send you a simple one-page form to fill out for your appeal. While convenient, this is rarely sufficient. A successful appeal requires a comprehensive legal brief that addresses policy language, medical evidence, and federal law. We provide a customized, multi-page appeal package that is far more robust than a standard form.
How long does MetLife have to decide on my appeal?
Once you submit your appeal, MetLife generally has 45 days to issue a decision. They can request one 45-day extension if they provide a valid reason (such as needing a new medical exam). If they fail to meet these deadlines, your claim may be "deemed exhausted," which can sometimes allow you to proceed directly to a lawsuit.
Can I update my medical evidence while the appeal is pending?
Yes. If you have a new surgery, a new test result (like an MRI or EMG), or a new specialist's opinion while MetLife is still reviewing your appeal, you should submit it immediately. Under ERISA, MetLife must consider "all comments, documents, records, and other information" you submit, regardless of whether it was in your initial claim.
Why does MetLife ask for "Impact Statements" during an appeal?
Impact statements are written testimonies from friends, family, or former coworkers that describe how your disability has changed your life. MetLife may not "ask" for them, but they are a powerful tool for your appeal. They provide "human" context that a cold medical chart cannot, proving that you can no longer function in a workplace environment.
What happens if MetLife denies my final appeal?
If your final administrative appeal is denied, you have "exhausted" your remedies under the plan. Your next step is to file a federal lawsuit under ERISA Section 502(a). Because we "build the record" during the appeal phase with the lawsuit in mind, we are often ready to file your complaint immediately following a final denial.
