Metropolitan Life Insurance coverage Firm—extra generally often called MetLife—is among the world’s largest monetary companies firms. Whereas MetLife is usually related to life insurance coverage and monetary companies, the corporate has a sturdy incapacity insurance coverage enterprise as properly.
When you’ve not too long ago had a long-term incapacity declare denied by MetLife, we perceive how pissed off you may really feel. Earlier than you quit and settle for MetLife’s resolution, it is best to seek the advice of with a incapacity insurance coverage lawyer at Bryant Authorized Group. We now have intensive expertise with MetLife incapacity insurance coverage appeals and can assist you perceive your authorized choices. Hold studying to study important steps it is best to take after a incapacity insurance coverage denial.
MetLife Has a Monitor File 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 hundreds of its purchasers’ pension claims. It needed to pay lots of of tens of millions to purchasers whose claims had been misplaced, delayed, or in any other case mishandled.
For giant firms like MetLife, their major objective is revenue. They course of hundreds of claims and reducing corners is extra widespread than any of us wish to admit. Nevertheless, there are methods you’ll be able to defend 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
In contrast to many different giant insurance coverage firms, MetLife at the moment doesn’t promote particular person incapacity insurance coverage insurance policies to personal people. Since September 2016, MetLife has solely provided group incapacity protection via worker profit applications.
Which means you probably have incapacity insurance coverage via MetLife, your plan is sort of actually ruled by a federal regulation often called the Worker Retirement Revenue Safety Act of 1974, or ERISA for brief. You’ve sure rights and protections beneath ERISA. Nevertheless, you additionally should observe strict pointers for the way and when you’ll be able to attraction a incapacity denial or file a lawsuit, and what proof you’re allowed to incorporate.
The rest of this weblog publish will primarily concentrate on the MetLife appeals course of beneath 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 distinct algorithm might apply to you. We are going to contact on this briefly towards the top of this text.
A Step-By-Step Take a look at the MetLife Lengthy-Time period Incapacity Appeals Course of
You could act rapidly as soon as your declare has been denied. Underneath ERISA, you solely have a restricted time to attraction, and also you wish to guarantee that preliminary attraction is as complete as potential. You may solely get one probability so as to add proof to the document.
Learn Your Denial Letter Rigorously
MetLife is legally required to offer two crucial 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 lined, or they don’t consider you meet the plan’s definition of incapacity.
- Their attraction procedures and pointers. Every incapacity insurance coverage firm has its personal administrative appeals course of, and beneath ERISA you have to attraction on to MetLife earlier than you’ll be able to file a lawsuit in court docket. You additionally may have a most of 180 days to file an attraction. Which 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 data 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 will get a significantly better sense of whether or not MetLife’s denial was official—and if not, the extra proof you’ll want to offer in your attraction 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 could be pricey.
The denial letter may make it appear to be MetLife’s appeals course of is easy and simple. It isn’t. Extra possible than not, you will want to current intensive proof and arguments in an organized manner.
You do not need to mess this up, and constructing a profitable attraction will take time even for an skilled legal professional. The earlier you get an expert to evaluate your case, the higher your possibilities of success.
Collect the Essential Proof
As soon as your legal professional critiques the denial letter, plan paperwork, and claims file—and determines you’ve got a great case—they are going to begin that will help you collect the related proof. This may embrace issues like:
- Further medical information
- Practical evaluations that measure your bodily and cognitive efficiency
- Vocational evaluations of your practical future employability and incomes capability
- Letters of help from docs and medical employees
- Letters of help from colleagues, members of the family, and different people who’re educated about your bodily and psychological capabilities, earlier than and after you turned disabled
- Images, movies, journal entries, and different recordings of your each day experiences and circumstances
- Another proof your long-term incapacity lawyer may take into account 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 critiques your attraction and makes its remaining resolution, you can not submit extra info, irrespective of how essential it’s to your case. Even when MetLife denies your attraction, and also you file a lawsuit, the court docket will solely be capable to evaluate the proof that’s already within the claims file.
Sadly, many individuals make the error of submitting an attraction with out extra proof. Your lawyer can assist you accumulate and submit proof that helps your allegations and paperwork your disabilities.
File Your Administrative Enchantment and Anticipate a Response
After you have your proof collectively, your legal professional will aid you put together and submit your attraction. It will embrace all the brand new proof you’re including to the claims file. It’ll additionally embrace an in depth attraction letter that outlines why, particularly, you disagree with MetLife’s willpower and consider your advantages ought to be authorized.
After you attraction, MetLife may 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 virtually three months to seek out out in case your attraction has been accepted.
Think about Authorized Motion If Your Enchantment Is Denied
In case your declare is denied, and there aren’t any extra necessary administrative appeals you have to undergo, your remaining possibility is to file a lawsuit in court docket.
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 to evaluate the prevailing proof in your claims file.
Despite the fact that no new proof could be added, your long-term incapacity lawyer will nonetheless be capable to symbolize your pursuits in court docket. They will 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 not sells particular person incapacity insurance coverage insurance policies to personal people, they nonetheless administer insurance policies that had been offered beforehand. You probably have certainly one of these “grandfathered” insurance policies, it might be ruled by your state’s contract legal guidelines reasonably than ERISA.
Generally, policyholders with non-ERISA plans have extra choices on the subject of appeals. For instance, you will not be required to finish an administrative evaluate 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, be sure you 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 not too long ago 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 purchasers assess their authorized choices, establish the right procedures, “stack” their evidentiary document, and negotiate with the long-term incapacity firm.
To study extra about our strategy and the way we’d have the opportunity that will help you, please contact us immediately to obtain a free and confidential session. You may attain Bryant Authorized Group by calling 312-561-3010 or finishing this transient on-line type.
