Disability Insurance Blog

Why Did MetLife Deny My Long Term Disability Claim?

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Wednesday, May 19th, 2021

If MetLife has denied or terminated your long-term disability insurance claim, and it is a policy through your employer, the first thing you need to know is the window of time to appeal the denial or termination is time sensitive. There are steps that can and should be taken, but if trying to do this on your own could lead to a financial disaster.  MetLife is expecting you to try and fail to defend your long-term disability insurance claim.  They will seek to rush this appeal process and then quickly close your claim forever.  This is one of its common tactics with claimants.

Why Would Met Life Deny Your Disability Claim?

How can your disability appeal fail when you and your doctor, coworkers, and family members all agree you are too sick or injured to work? Unfortunately, the disability insurance company is looking at your file, and thousands of people just like you, through a very different lens.

When MetLife, or Cigna or any other disability insurance company denies a disability claim, it is doing so based on statistics. Consider how much money MetLife would have to pay out if your claim was paid exactly as you thought it would be—then multiply that number by several million per year.  It is also using statistics (often created by biased entities) to determine “disability durations” or guidelines for how a condition will support disability (and usually woefully underrepresenting reality).

Disability insurance, like any insurance product, is an educated and highly analyzed guess as to how many people are going to pay premiums, how many are going to file a claim and how many are going to actively fight back when a claim is made.   If every claimant who received a denial fought back with an aggressive and experienced disability law firm on their side, it would still make financial sense for MetLife to deny claims. But MetLife is counting on a large number of people trying to appeal their disability insurance claim on their own and failing, or people giving up altogether.

The appeals process is more complicated than simply providing additional copies of new medical reports and uploading a disability appeal form stating that you disagree.  And the numbers are on MetLife’s side. There are no penalties created for MetLife when it denies a claim. ERISA disability insurance policies are not subject to damages claims, even if the denial causes people tremendous financial and emotional hardship. The only thing MetLife has to lose is the cost of the people they hire to deny and maintain a denial of your claim.

How Does Met Life Deny Disability Claims?

 The disability law firm Frankel & Newfield has represented many people whose disability claims were denied and needed experienced help with filing an appeal. We know from the many cases we’ve handled that Met Life relies on a cozy relationship with third-party companies that it hires to review patient medical records.

That’s right: your disability insurance claim, which you counted on to protect your family in case of disability, is not being reviewed by independent medical boards of examiners. Instead, the people making this decision about your financial future are largely doctors and nurses who don’t work with patients in a clinical setting. Instead, their full-time job is working at a company that reviews medical records as a subcontractor for MetLife. Their employment and that of the third-party company they work for depends upon the insurance company for income. This glaring conflict of interest is something we fight against on a regular basis.

Another issue that we see on a frequent basis are flawed vocational reviews. Many of the sources used to create descriptions of the “material tasks and duties” of your occupation are outdated or simply wrong. The nature of someone who has to reach across a bank service counter to take something from another person is not the same as the person who stands over patient for many hours to perform dentistry. But both are often lumped into the same category.  These vocational reviews often fail to consider any of the non-physical work duties, casting people into wide bundles of “physical capacity”.

MetLife maintains a close relationship between them and its medical experts and the occupational experts – who usually find a result that benefits the disability insurance policy.  This is no surprise to the disability lawyers at Frankel & Newfield – nor to some courts, who have noted have these doctors have “had their bread buttered” by the insurance company.  We see this on a regular basis, and battle against it on behalf of our clients every single day.

Frankel & Newfield attorneys are also aware that the MetLife claims department systems track exactly when a disability insurance policy transitions from “own occupation” to “any occupation.” If your policy has this provision, where the definition of disability changes at a point in time, that’s when you can expect to receive a letter indicating that you are no longer disabled.   This is the secondary battle for claimants who have navigated their initial claim.

Your medical status has not changed, but your policy insuring your ability to perform the material tasks and duties of your former job has changed to one that only insures your ability to perform the material tasks and duties of any job.  This loose standard offers MetLife good opportunity to impact the claim.

What You Should Know About MetLife

MetLife is a global insurance company, founded in 1868, that has sold employee benefit insurance, including disability insurance policies, for 60 years. If you work for 95 of the top Fortune 100 companies, chances are your employee benefits include insurance policies from MetLife. The company sells financial and insurance products in more than 115 countries. MetLife is an enormous company with limitless resources.

How can one person’s fight for their disability insurance benefits possibly stand up to such a large company? It’s not easy — and you don’t want to do this on your own. We recommend that you make a call –it’s free – and speak with the disability insurance lawyers at Frankel & Newfield. You can reach us at 877-583-2524 for a free consultation.

Why Can’t I Handle a Disability Appeal on my Own?

Appealing an ERISA disability claim denial is not something that is easy to do – even insurance executives and lawyers fail when they try to appeal an ERISA (group policy benefit) or private (purchased as an individual) disability denial. We know that because we represent many insurance executives and attorneys when they attempt to overturn a claim denial.

When we handle an appeal, we take apart the claim decision like the foundation of a home – and make the house crumble, leaving no basis for the claim determination.  This formula for success has led to many clients succeeded in this difficult process.

How can one person’s fight for their disability insurance benefits possibly stand up to such a large company? It’s not easy — and you don’t want to do this on your own. We recommend that you make a call –it’s free – and speak with the disability insurance lawyers at Frankel & Newfield. You can reach us at 877-583-2524 for a free consultation.

 

Jason A. Newfield

Written By:

Jason A. Newfield

Disability Insurance Attorney