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What To Do After Metlife Denies LTD Coverage

by | May 14, 2022 | Firm News

MetLife is a venerable institution in the world of insurance. Founded in 1868 as the Metropolitan Life Insurance Company, MetLife now has 90 million customers in 60 countries and is traded on the New York Stock Exchange. When it comes to its long-term disability (LTD) policies, however, the company has a well-known track record of denying claims.

MetLife offers its LTD policies through employers, and there is no “one size fits all” policy for these employers. Some contain different exclusions and definitions than others. If you’re a MetLife LTD policyholder who’s been denied your benefits, or better, before you even file your claim, obtain a full copy of the policy if you don’t already have one. Read the fine print, and then contact a disability attorney to weigh your options.

If you’re in or around Minneapolis, Minnesota, and you’ve been denied an LTD claim by MetLife, contact Beedem Law immediately. Our attorneys are familiar with MetLife and understand their tactics and how to appeal your claim for the financial security you deserve under the terms of your policy. We also proudly serve clients in St. Paul, Duluth, and throughout the counties of Hennepin, Ramsey, Dakota, and Anoka, Minnesota.

Reasons MetLife May Deny Your LTD Claim

MetLife, like all insurance companies, is in business to make money, so they constantly monitor claims to limit what insurers call their exposure – in other words, their financial liability. When it comes to claims for long-term disability, MetLife is not alone – but maybe more aggressive – when examining and challenging the medical evidence behind the claim.

Typical reasons for denial include:

  • Not meeting the definition of “disabled” under terms of your policy
  • Having your disability excluded because it stems from a pre-existing condition
  • Your claim lacked sufficient medical evidence (lacking X-Rays, MRIs, test results, etc.)
  • You self-reported your symptoms without medical backup statements
  • MetLife doctors disagreed with your doctor’s evaluation
  • You were surveilled and observed doing things your claimed disability wouldn’t allow you to do

Regarding the first reason cited above, you should be aware that different policies have different standards for when you qualify for monthly disability benefits. Some policies will honor claims if you cannot perform the duties of your current job (typically called “own occupation”), while others will provide benefits only if you cannot perform the duties of “any occupation.”

This is why you need a copy of your LTD policy — to confirm if your disability is covered for the work you most recently performed before becoming disabled. If not, and your policy covers your disability only if you cannot work any job, even sitting at a desk answering phones, you can be denied.

Even when you submit the full range of medical documentation and results, MetLife can still – and often does – deny your claim based on the evaluation of your medical evidence by its team of medical advisers. It can also send out a surveillance crew to follow you around in public and see if you really are as disabled as you claim.

What to Do If You Are Denied

If you are denied your claim, MetLife will send you a letter outlining the rationale for its decision, defining the appeals process, and the deadlines you need to meet. You will need to bring this letter to your LTD attorney to formulate your strategy for a timely appeal. If you miss the deadline, you cannot go to court to ask for a reversal of the denial.

LTD policies purchased through your employer are covered by the Employee Retirement Income Security Act (ERISA). Despite the title’s emphasis on “employee,” ERISA has many provisions that favor the insurance company, and thus the appeals process must begin with navigating a bunch of administrative hurdles before you can even file a lawsuit.

To facilitate the appeals process, request a copy of your claim file from MetLife. Working with your attorney, you can then assemble the documentation that may have been missing from your original claim, or update the medical records for submission with the appeal.

It’s essential to note here that, should your appeal be denied by MetLife and you choose to file a lawsuit, only the documentation you submitted to MetLife before the legal action can be considered by the judge. Hiring a lawyer can help you “stack your administrative record,” which can be useful for your appeal, especially if it is denied.

Experience You Can Trust: Beedem Law

Time is of the essence when appealing an LTD denial. You need to contact us at Beedem Law immediately and bring your denial letter, a copy of your policy, and copies of the documentation you submitted with your claim so we can review everything. Better yet, before you file – which you also must do in a timely fashion – consult with us to assemble a package of documentation that is comprehensive and convincing.

The long-term disability attorneys at Beedem Law proudly serve clients in Minneapolis, St. Paul, Duluth, and in the counties of Hennepin, Ramsey, Dakota, and Anoka, Minnesota. Contact us immediately for a free consultation when you have a disability claim or a denial of a claim, and let’s work together to protect your rights.