Metropolitan Life Insurance coverage Firm—extra generally often known as MetLife—is without doubt one of the world’s largest monetary companies firms. Whereas MetLife is usually related to life insurance coverage and monetary companies, the corporate has a strong incapacity insurance coverage enterprise as properly.
In case you’ve just lately had a long-term disability claim denied by MetLife, we perceive how pissed off you would possibly really feel. Earlier than you surrender and settle for MetLife’s choice, you need to seek the advice of with a incapacity insurance coverage lawyer at Bryant Authorized Group. We have now in depth expertise with MetLife incapacity insurance coverage appeals and can assist you perceive your authorized choices. Hold studying to study important steps you need to take after a incapacity insurance coverage denial.
MetLife Has a Observe Report of Denying Legitimate Claims
Whereas many people affiliate MetLife with pleasant photos of blimps at sporting occasions and promoting with cartoon characters, it’s a hard-nosed, savvy firm. It has typically run afoul of state insurance coverage regulators.
MetLife has a historical past of mishandling claims and even dropping them. In January of 2019, New York regulators fined MetLife $19.75 million for mishandling and misplacing 1000’s of its purchasers’ pension claims. It needed to pay a whole lot of hundreds of thousands to purchasers whose claims had been misplaced, delayed, or in any other case mishandled.
For big firms like MetLife, their main aim is revenue. They course of 1000’s of claims and reducing corners is extra widespread than any of us wish to admit. Nevertheless, there are methods you’ll be able to shield your self and enhance your probability of getting the incapacity advantages you deserve.
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Most MetLife Incapacity Insurance coverage Plans Are Ruled by ERISA
Not like many different massive insurance coverage firms, MetLife at present doesn’t promote particular person incapacity insurance coverage insurance policies to non-public people. Since September 2016, MetLife has solely supplied group incapacity protection by means of worker profit applications.
Meaning in case you have incapacity insurance coverage by means of MetLife, your plan is nearly actually ruled by a federal regulation often known as the Employee Retirement Income Security Act of 1974, or ERISA for brief. You’ve gotten sure rights and protections beneath ERISA. Nevertheless, you additionally should comply with strict pointers for a way and when you’ll be able to enchantment a incapacity denial or file a lawsuit, and what proof you’re allowed to incorporate.
The rest of this weblog put up will primarily give attention to the MetLife appeals course of beneath ERISA.
In case you did buy a person incapacity insurance coverage coverage instantly from MetLife (not by means of an employer) earlier than September 2016, and that coverage stays in power, a unique algorithm could apply to you. We are going to contact on this briefly towards the top of this text.
A Step-By-Step Have a look at the MetLife Lengthy-Time period Incapacity Appeals Course of
It’s essential to act shortly as soon as your declare has been denied. Below ERISA, you solely have a restricted time to enchantment, and also you wish to be sure that preliminary enchantment is as complete as doable. You would possibly solely get one likelihood so as to add proof to the report.
Learn Your Denial Letter Rigorously
MetLife is legally required to supply two important items of knowledge of their denial letter:
- The particular motive they denied your declare. For instance, they could say you didn’t present sufficient proof, your situation isn’t lined, or they don’t consider you meet the plan’s definition of incapacity.
- Their enchantment procedures and pointers. Every incapacity insurance coverage firm has its personal administrative appeals course of, and beneath ERISA it’s essential to enchantment on to MetLife earlier than you’ll be able to file a lawsuit in courtroom. You additionally may have a most of 180 days to file an enchantment. Which may sound like rather a lot, but it surely isn’t.
Request a Copy of Your Claims File
MetLife could have supplied this along with your denial letter—but when they didn’t, request it instantly. Your claims file ought to embody all the data that MetLife used to make their willpower. This might embody medical data, job descriptions, and different proof.
By reviewing your denial letter, your claims file, and your plan paperwork, you will get a significantly better sense of whether or not MetLife’s denial was legit—and if not, the extra proof you’ll want to supply on your enchantment to achieve success.
Contact a Lengthy-Time period Incapacity Lawyer
ERISA appeals are extraordinarily dangerous to attempt to sort out by yourself. The stakes are excessive and errors might be expensive.
The denial letter would possibly make it look like MetLife’s appeals course of is straightforward and simple. It isn’t. Extra possible than not, you have to to current in depth proof and arguments in an organized approach.
You don’t want to mess this up, and constructing a profitable enchantment will take time even for an skilled lawyer. The earlier you get an expert to evaluation your case, the higher your probabilities of success.
Collect the Vital Proof
As soon as your lawyer evaluations the denial letter, plan paperwork, and claims file—and determines you’ve an excellent case—they’ll begin that can assist you collect the related proof. This would possibly embody issues like:
- Further medical data
- Practical evaluations that measure your bodily and cognitive efficiency
- Vocational evaluations of your life like future employability and incomes capability
- Letters of help from medical doctors and medical employees
- Letters of help from colleagues, relations, and different people who’re educated about your bodily and psychological capabilities, earlier than and after you turned disabled
- Pictures, movies, journal entries, and different recordings of your each day experiences and circumstances
- Some other proof your long-term incapacity lawyer would possibly think about related to your case
Make Positive Your Evidentiary Report Is Full
In an ERISA declare, you solely have a restricted period of time to submit proof. As soon as MetLife evaluations your enchantment and makes its remaining choice, you can not submit further info, irrespective of how vital it’s to your case. Even when MetLife denies your enchantment, and also you file a lawsuit, the courtroom will solely be capable of evaluation the proof that’s already within the claims file.
Sadly, many individuals make the error of submitting an enchantment with out further proof. Your lawyer can assist you accumulate and submit proof that helps your allegations and paperwork your disabilities.
File Your Administrative Enchantment and Look ahead to a Response
After you have your proof collectively, your lawyer will assist you put together and submit your enchantment. This can embody all the brand new proof you’re including to the claims file. It’ll additionally embody an in depth enchantment letter that outlines why, particularly, you disagree with MetLife’s willpower and consider your advantages needs to be accredited.
After you enchantment, MetLife may have an preliminary deadline of 45 days to reply. This may be prolonged one time for a further 45 days, so you would be ready nearly three months to search out out in case your enchantment has been accepted.
Take into account Authorized Motion If Your Enchantment Is Denied
In case your declare is denied, and there aren’t any extra obligatory administrative appeals it’s essential to undergo, your remaining possibility is to file a lawsuit in courtroom.
From right here, your case will possible be reviewed by a decide (not a jury) and, as famous above, the decide will solely be capable of evaluation the prevailing proof in your claims file.
Regardless that no new proof might be added, your long-term incapacity lawyer will nonetheless be capable of symbolize your pursuits in courtroom. They’ll put together written briefs, current oral arguments, and clarify and interpret proof within the report.
What If I Have an Particular person Incapacity Insurance coverage Plan?
Though MetLife not sells particular person incapacity insurance coverage insurance policies to non-public people, they nonetheless administer insurance policies that had been bought beforehand. When you have one in all these “grandfathered” insurance policies, it might be ruled by your state’s contract legal guidelines quite than ERISA.
Generally, policyholders with non-ERISA plans have extra choices relating to appeals. For instance, you might not be required to finish an administrative evaluation earlier than submitting a lawsuit, and also you might be able to request a full jury trial.
As a result of every state has a novel set of contract legal guidelines, remember to contact a long-term incapacity lawyer in your state as quickly as doable to start reviewing your authorized choices.
RELATED POST: Appealing Denied Private Disability Insurance Claims – Bryant Legal Group (bryantlg.com)
Bryant Authorized Group: Incapacity Attorneys Who Can Struggle for Your Rights
If MetLife just lately denied your incapacity declare, it’s in your finest curiosity to seek the advice of with a talented lawyer at Bryant Authorized Group. We’re proud to assist our purchasers assess their authorized choices, determine the proper procedures, “stack” their evidentiary report, and negotiate with the long-term incapacity firm.
To study extra about our strategy and the way we would have the option that can assist you, please contact us in the present day to obtain a free and confidential session. You possibly can attain Bryant Authorized Group by calling 312-561-3010 or completing this brief online form.
