Metropolitan Life Insurance coverage Firm—extra generally generally known as MetLife—is without doubt one of the world’s largest monetary providers corporations. Whereas MetLife is usually related to life insurance coverage and monetary providers, the corporate has a strong incapacity insurance coverage enterprise as nicely.
If you happen to’ve lately had a long-term incapacity declare denied by MetLife, we perceive how annoyed you may really feel. Earlier than you quit and settle for MetLife’s resolution, it’s best to seek the advice of with a incapacity insurance coverage lawyer at Bryant Authorized Group. We’ve intensive expertise with MetLife incapacity insurance coverage appeals and may also help you perceive your authorized choices. Preserve studying to be taught 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 photographs 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 shedding them. In January of 2019, New York regulators fined MetLife $19.75 million for mishandling and misplacing 1000’s of its shoppers’ pension claims. It needed to pay tons of of hundreds of thousands to shoppers whose claims had been misplaced, delayed, or in any other case mishandled.
For giant corporations like MetLife, their main objective is revenue. They course of 1000’s of claims and reducing corners is extra frequent than any of us need to admit. Nonetheless, 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 corporations, 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 worker profit applications.
Which means when you’ve got incapacity insurance coverage by MetLife, your plan is sort of actually ruled by a federal regulation generally known as the Worker Retirement Earnings Safety Act of 1974, or ERISA for brief. You’ve sure rights and protections beneath 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 put up will primarily deal with the MetLife appeals course of beneath ERISA.
If you happen to did buy a person incapacity insurance coverage coverage straight from MetLife (not by an employer) earlier than September 2016, and that coverage stays in drive, a distinct algorithm might apply to you. We are going to contact on this briefly towards the tip of this text.
A Step-By-Step Take a look at the MetLife Lengthy-Time period Incapacity Appeals Course of
It’s essential to act rapidly as soon as your declare has been denied. Below ERISA, you solely have a restricted time to enchantment, and also you need to be sure that preliminary enchantment is as complete as potential. You may solely get one probability so as to add proof to the document.
Learn Your Denial Letter Fastidiously
MetLife is legally required to offer two important items of knowledge of their denial letter:
- The particular 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 beneath ERISA you need 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. That may sound like lots, nevertheless it isn’t.
Request a Copy of Your Claims File
MetLife might have offered 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 willpower. 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 official—and if not, the extra proof you’ll want to offer 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 will be pricey.
The denial letter may make it seem to be MetLife’s appeals course of is straightforward and easy. It isn’t. Extra probably than not, you’ll need to current intensive proof and arguments in an organized manner.
You don’t want to mess this up, and constructing a profitable enchantment will take time even for an skilled legal professional. The earlier you get knowledgeable to evaluation your case, the higher your probabilities of success.
Collect the Mandatory Proof
As soon as your legal professional opinions the denial letter, plan paperwork, and claims file—and determines you’ve gotten case—they may begin that can assist you collect the related proof. This may embrace issues like:
- Further medical information
- Purposeful evaluations that measure your bodily and cognitive efficiency
- Vocational evaluations of your lifelike future employability and incomes capability
- Letters of assist from docs and medical workers
- Letters of assist from colleagues, relations, and different people who’re educated about your bodily and psychological capabilities, earlier than and after you grew to become disabled
- Photographs, movies, journal entries, and different recordings of your every day experiences and circumstances
- Some other proof your long-term incapacity lawyer may think about 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 last resolution, you can not submit extra data, irrespective of how necessary it’s to your case. Even when MetLife denies your enchantment, and also you file a lawsuit, the courtroom will solely have the ability to evaluation the proof that’s already within the claims file.
Sadly, many individuals make the error of submitting an enchantment with out extra proof. Your lawyer may also help you acquire and submit proof that helps your allegations and paperwork your disabilities.
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File Your Administrative Enchantment and Watch for a Response
After you have your proof collectively, your legal professional will show you how to put together and submit your enchantment. This may 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 willpower and imagine your advantages needs to be authorized.
After you enchantment, MetLife may have an preliminary deadline of 45 days to reply. This may be prolonged one time for an extra 45 days, so you could possibly be ready virtually 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 necessary administrative appeals you need to undergo, your last choice is to file a lawsuit in courtroom.
From right here, your case will probably be reviewed by a choose (not a jury) and, as famous above, the choose will solely have the ability to evaluation the prevailing proof in your claims file.
Although no new proof will be added, your long-term incapacity lawyer will nonetheless have the ability to symbolize your pursuits in courtroom. They’ll put together written briefs, current oral arguments, and clarify and interpret proof within the document.
What If I Have an Particular person Incapacity Insurance coverage Plan?
Though MetLife now 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 certainly one of these “grandfathered” insurance policies, it might be ruled by your state’s contract legal guidelines moderately than ERISA.
Generally, policyholders with non-ERISA plans have extra choices with regards to appeals. For instance, you will not be required to finish an administrative evaluation earlier than submitting a lawsuit, and also you could possibly 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 potential to start reviewing your authorized choices.
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Bryant Authorized Group: Incapacity Legal professionals Who Can Struggle for Your Rights
If MetLife 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 shoppers assess their authorized choices, establish the right procedures, “stack” their evidentiary document, and negotiate with the long-term incapacity firm.
To be taught extra about our strategy and the way we would find a way that can assist you, please contact us right now to obtain a free and confidential session. You’ll be able to attain Bryant Authorized Group by calling 312-561-3010 or finishing this transient on-line kind.
