At Disability Insurance Law Group, our national claims attorneys know that, according to their online profile, “With 153 years of experience, MetLife is a leading innovator and a recognized leader in protection planning solutions worldwide. Our name is recognized and trusted by tens of millions of customers worldwide, and we do business with 96 of the top 100 FORTUNE 500® companies in the United States.”
While MetLife’s profile is impressive, it can be intimidating to those seeking disability benefits from the corporation. Unfortunately, the process often does not stop at intimidation. Disability insurance is designed to provide income if a worker cannot perform their work due to disability. While they are working through the challenges associated with being unable to work because of their disabling condition, being met with resistance to accessing their benefits can be overwhelming.
That is why we are here. Our disability insurance attorneys represent MetLife policyholders nationwide — no matter where they live or work in the U.S. — with their best interests and true success in mind so our clients can pursue the benefits they are entitled to from their employer-provided coverage or personal policies.
Like many large disability insurers, MetLife carefully reviews claims before approving benefits. This review process often involves examining medical records, physician statements, job descriptions, and the policy’s definition of disability.
Even when claimants provide substantial documentation, the insurer may still question whether the medical condition prevents the individual from performing the duties of their occupation.
Some common issues that arise in MetLife disability claims include:
For individuals who rely on disability benefits to replace lost income, these disputes can create significant financial and emotional stress. Many claimants are unsure how to respond when the insurer requests additional information or denies a claim despite extensive medical documentation.
Understanding how MetLife evaluates disability claims can help claimants determine the next steps if a claim is delayed or denied.
Many MetLife disability policies are issued through large employer benefit plans or union-sponsored coverage programs. These group policies are common in several professions and industries.
MetLife frequently administers disability coverage for workers, such as:
Teachers and school employees, in particular, often receive disability coverage through union-negotiated benefit packages or school district group plans. These policies may include both short-term and long-term disability benefits and are often governed by the Employee Retirement Income Security Act of 1974 (ERISA).
Because these policies are part of employer or union benefit plans, many workers assume the claim process will be straightforward. However, group disability claims can involve detailed reviews of medical evidence, occupational duties, and policy definitions.
Understanding the terms of a group disability policy is important because the insurer may closely analyze whether the claimant can perform the specific duties of their occupation or another type of work.
Another issue that frequently arises in MetLife disability claims involves the initial claim application and supporting forms.
When a claimant applies for disability benefits, the insurance company typically requires several pieces of documentation, including:
These documents are often reviewed very closely by the insurance company. In some situations, MetLife may deny a claim by pointing to perceived inconsistencies between the medical records, physician statements, and the claimant’s description of their limitations.
For example, the insurer may argue that:
When a claim is denied for these reasons, the appeal process may require clarifying the medical evidence and providing additional documentation explaining how the condition affects the claimant’s ability to work.
Carefully preparing the claim application and supporting documentation can play an important role in protecting a claimant’s right to disability benefits.
Many MetLife disability policies are provided through employer-sponsored benefit plans. These group policies often cover employees in industries such as education, healthcare, finance, government, and corporate services.
Group disability plans may include coverage for:
Short-term disability benefits.
Long-term disability benefits.
Supplemental disability coverage.
Additional accident-related protections.
Because these policies are typically part of employee benefit packages, many workers assume their claim will be straightforward if they become unable to work. However, the claims process for group disability policies can still be complex and may involve detailed reviews of medical evidence, job duties, and policy definitions.
In many situations, these employer-provided disability policies are governed by federal law under ERISA, which establishes specific rules for claims and appeals.
Another issue that sometimes arises in MetLife claims involves the relationship between disability benefits and Accidental Death and Dismemberment (AD&D) coverage.
Some employee benefit packages include both disability insurance and AD&D coverage. While these benefits are separate, confusion can sometimes arise about which type of coverage applies to a particular situation.
AD&D coverage typically applies to injuries caused by specific types of traumatic events. At the same time, disability insurance benefits are designed to provide income replacement when a person cannot perform their occupation due to a medical condition.
Understanding how these benefits interact can be important when evaluating a claim. In some cases, claimants may qualify for multiple types of benefits depending on the circumstances of their condition and the terms of the policy.
Careful review of the policy language and medical documentation can help determine which benefits may be available.
For many U.S. workers, their employers offer disability benefits as part of their employment packages. This is especially true for most group policies governed by the Employee Retirement Income Security Act of 1974 (ERISA), millions of which MetLife underwrites.
The key differences between an ERISA disability plan and a private disability insurance policy lie in their regulatory frameworks, the entities that offer them, and the legal protections they provide to policyholders.
To follow is a breakdown of the distinctions:
ERISA sets standards for establishing and operating employer-sponsored benefit plans, including disability insurance.
ERISA disability policies are typically included in an employer-sponsored benefits package. Employers often purchase group disability insurance plans for their employees.
ERISA imposes specific legal requirements on employers providing disability benefits, including disclosure obligations and procedures for filing claims and appeals. It establishes rules and standards to protect plan participants’ interests.
ERISA preempts many state insurance laws, which can impact the legal remedies available to policyholders. ERISA disability claims are subject to federal law, and there are limitations on the types of lawsuits that can be filed in state courts.
ERISA disability claims are often subject to a “deferential” or “arbitrary and capricious” standard of review by the courts. This means that, in legal challenges, courts may defer to the plan administrator’s decisions unless those decisions are found to be unreasonable.
Private disability insurance policies not part of an employer-sponsored plan are regulated by state insurance laws. These laws vary by state and may include requirements related to policy language, consumer protections, and claims handling.
Private disability insurance policies can be purchased individually by individuals who want coverage outside or in addition to employer-sponsored plans.
While state insurance laws provide specific protections for policyholders, the legal framework for individual disability insurance is generally less standardized than ERISA. Legal remedies and standards can vary by jurisdiction.
Unlike ERISA disability claims, which are typically litigated in federal court, private disability insurance claims may be filed in state courts, allowing policyholders to pursue legal remedies under state laws.
Legal challenges to denials of private disability insurance claims may be subject to a different standard of review, meaning the court reviews the claim without giving deference to the insurer’s decision.
It’s essential for individuals to carefully review the terms and conditions of their disability insurance policies, whether ERISA or private, and understand the legal framework that applies to their specific coverage. We can help.
Receiving a disability claim denial can be overwhelming, particularly when a person is already dealing with serious medical conditions and financial uncertainty.
If MetLife denies a disability claim, the denial letter typically explains the insurer’s reasoning and provides instructions for filing an appeal.
Before submitting an appeal, it may be helpful to:
The appeal stage can be extremely important, especially for ERISA-governed disability policies. In many cases, the evidence submitted during the appeal may determine what information a court can later consider.
Whether you are considering applying for benefits, are waiting for a claim’s decision, or have been denied, we can assist you with your MetLife disability claim anywhere in the country, starting with a free consultation.
We are fully dedicated to providing transparent legal services that deliver real results for real people who need our help – no matter where they live or work in the U.S.
If you are receiving resistance from MetLife for your U.S. disability claim, or if your claim has already been denied, contact our dedicated disability insurance attorneys nationwide at 954-324-2335 or online to schedule a free, confidential case assessment without delay.
Fill out the form and we’ll be in touch with you shortly, or call us now at 954-989-9000.
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