Metropolitan Life Insurance coverage Firm—extra generally generally known as MetLife—is without doubt one of the world’s largest monetary providers firms. Whereas MetLife is usually related to life insurance coverage and monetary providers, the corporate has a sturdy incapacity insurance coverage enterprise as nicely.
When you’ve just lately had a long-term incapacity declare denied by MetLife, we perceive how annoyed you may really feel. Earlier than you surrender and settle for MetLife’s choice, it’s best 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 might help you perceive your authorized choices. Maintain studying to study important steps it’s best to take after a incapacity insurance coverage denial.
MetLife Has a Observe File of Denying Legitimate Claims
Whereas many people affiliate MetLife with pleasant pictures of blimps at sporting occasions and promoting with cartoon characters, it’s a hard-nosed, savvy firm. It has generally 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 hundreds of its shoppers’ pension claims. It needed to pay a whole bunch of hundreds of thousands to shoppers whose claims have been misplaced, delayed, or in any other case mishandled.
For giant firms like MetLife, their main purpose is revenue. They course of hundreds of claims and reducing corners is extra frequent than any of us need to admit. Nonetheless, there are methods you’ll be able to defend your self and enhance your probability of getting the incapacity advantages you deserve.
RELATED ARTICLE: When Ought to I Converse With a Incapacity Lawyer?
Most MetLife Incapacity Insurance coverage Plans Are Ruled by ERISA
Not like many different giant 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 provided group incapacity protection via worker profit packages.
Meaning when you’ve got incapacity insurance coverage via MetLife, your plan is nearly actually ruled by a federal legislation generally known as the Worker Retirement Revenue Safety Act of 1974, or ERISA for brief. You’ve gotten sure rights and protections below ERISA. Nonetheless, you additionally should comply with strict pointers for the 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 submit will primarily give attention to the MetLife appeals course of below ERISA.
When you did buy a person incapacity insurance coverage coverage straight from MetLife (not via an employer) earlier than September 2016, and that coverage stays in power, a special algorithm could apply to you. We are going to contact on this briefly towards the tip of this text.
A Step-By-Step Have a look at the MetLife Lengthy-Time period Incapacity Appeals Course of
You should act shortly as soon as your declare has been denied. Underneath ERISA, you solely have a restricted time to enchantment, and also you need to guarantee that preliminary enchantment is as complete as doable. You may solely get one likelihood so as to add proof to the report.
Learn Your Denial Letter Rigorously
MetLife is legally required to offer two crucial items of knowledge of their denial letter:
- The precise cause they denied your declare. For instance, they may say you didn’t present sufficient proof, your situation isn’t coated, or they don’t imagine 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 below ERISA you need to enchantment on to MetLife earlier than you’ll be able to file a lawsuit in court docket. You additionally could have a most of 180 days to file an enchantment. That may sound like loads, however it 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 embrace all the knowledge that MetLife used to make their dedication. This might embrace medical information, job descriptions, and different proof.
By reviewing your denial letter, your claims file, and your plan paperwork, you may get a a lot better sense of whether or not MetLife’s denial was reliable—and if not, the extra proof you’ll want to offer in 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 will be expensive.
The denial letter may make it seem to be MetLife’s appeals course of is straightforward and simple. It isn’t. Extra doubtless than not, you will want to current in depth proof and arguments in an organized means.
You do not need to mess this up, and constructing a profitable enchantment will take time even for an skilled legal professional. The earlier you get an expert to evaluation your case, the higher your probabilities of success.
Collect the Needed Proof
As soon as your legal professional opinions the denial letter, plan paperwork, and claims file—and determines you have got an excellent case—they’ll begin that will help you collect the related proof. This may embrace issues like:
- Extra medical information
- Practical evaluations that measure your bodily and cognitive efficiency
- Vocational evaluations of your reasonable future employability and incomes capability
- Letters of help from medical doctors and medical workers
- Letters of help from colleagues, relations, and different people who’re educated about your bodily and psychological capabilities, earlier than and after you grew to become disabled
- Pictures, movies, journal entries, and different recordings of your day by day experiences and circumstances
- Another proof your long-term incapacity lawyer may contemplate related to your case
Make Certain Your Evidentiary File Is Full
In an ERISA declare, you solely have a restricted period of time to submit proof. As soon as MetLife opinions your enchantment and makes its closing choice, you can not submit further info, irrespective of how essential it’s to your case. Even when MetLife denies your enchantment, and also you file a lawsuit, the court docket 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 might help you acquire and submit proof that helps your allegations and paperwork your disabilities.
File Your Administrative Enchantment and Anticipate a Response
After getting your proof collectively, your legal professional will provide help to put together and submit your enchantment. This can embrace all the brand new proof you’re including to the claims file. It’s going to additionally embrace an in depth enchantment letter that outlines why, particularly, you disagree with MetLife’s dedication and imagine your advantages must be accepted.
After you enchantment, MetLife could have an preliminary deadline of 45 days to reply. This may be prolonged one time for an extra 45 days, so you might be ready nearly three months to search out out in case your enchantment has been accepted.
Think about Authorized Motion If Your Enchantment Is Denied
In case your declare is denied, and there are not any extra obligatory administrative appeals you need to undergo, your closing possibility is to file a lawsuit in court docket.
From right here, your case will doubtless be reviewed by a choose (not a jury) and, as famous above, the choose will solely be capable of evaluation the prevailing proof in your claims file.
Though no new proof will be added, your long-term incapacity lawyer will nonetheless be capable of signify your pursuits in court docket. 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 have been offered beforehand. When you have certainly one of these “grandfathered” insurance policies, it might be ruled by your state’s contract legal guidelines fairly than ERISA.
Usually, policyholders with non-ERISA plans have extra choices in relation to appeals. For instance, you is probably not 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, make sure to contact a long-term incapacity lawyer in your state as quickly as doable to start reviewing your authorized choices.
RELATED POST: Interesting Denied Non-public Incapacity Insurance coverage Claims – Bryant Authorized Group (bryantlg.com)
Bryant Authorized Group: Incapacity Attorneys Who Can Combat for Your Rights
If MetLife just lately denied your incapacity declare, it’s in your greatest curiosity to seek the advice of with a talented lawyer at Bryant Authorized Group. We’re proud to assist our shoppers assess their authorized choices, determine the right procedures, “stack” their evidentiary report, and negotiate with the long-term incapacity firm.
To study extra about our strategy and the way we’d give you the option that will help 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 finishing this temporary on-line kind.
