Our client (Mr. X), a stockbroker in New York, experienced anxiety and major depression as the result of family related issues and the death of his mother after her long battle with cancer. His treating psychiatrist and therapist both advised him to avoid as much stress as possible and take a medical leave of absence from his job in order to focus on his mental health and take the steps necessary to become fully functional. Mr. X submitted the claim forms and physician statements in support of his disability claim and fully expected his disability insurance carrier, MetLife, to pay disability benefits while he was undergoing therapy and until he was functional enough to return to his job. Despite clear evidence of disabling anxiety and depression, MetLife determined that the medical records did not clearly establish Mr. X’s limitations or inability to work and denied benefits. He then hired DI Law Group to file the appeal.
Most insureds reasonably assume that if they experience a medical condition that is severe enough to prevent them from properly and effectively doing their job then their disability insurance company will pay the benefits promised under the disability policy. Unfortunately, that does not tend to be the case. Insurance adjusters review claims very narrowly, looking for specific words, test results, and objective medical findings in order to support the approval or denial of a claim for disability benefits. Rarely do they look at the claimant as a person or consider the totality of the medical conditions and circumstances surrounding the claimant’s inability to work. Of course not every illness warrants diagnostic tests and doctors do not often include information in their records that addresses the specific concerns of a disability insurance company because they are not obligated to do so and such information is not usually necessary for the treatment of the patient. Thus, valid disability claims often get denied because the claim forms and medical records do not contain the “proof” the carrier is looking for.
At DI Law Group, when we are hired by a client to help them prepare an application for disability benefits we work closely with the client, their physicians, and their employer to make sure that the insurance company has all the information we know is required to approve a claim for benefits. The claim forms usually do not provide sufficient space for a complete response to their questions nor do they ask for pertinent information that would help the carrier fully understand the claimant’s limitations. As such, we work with our clients to provide the relevant information and evidence needed for a claim to be approved. In the case of Mr. X, our firm prepared an appeal which included extensive medical and occupational information in support of his claims as well as detailed statements from his treating psychiatrist and therapist, which we worked with the doctors to prepare. Those documents were submitted with an appeal letter reminding MetLife of its legal obligations under the disability contract and the law. Within 45 days of receiving the appeal, MetLife overturned its denial of benefits and sent Mr. X a check for all retroactive benefits due to date. DI Law Group continues to represent Mr. X in this matter and his monthly benefits have continued without interruption.
If you are considering filing a claim, have filed a claim that has not yet been approved, are dealing with a denial of benefits, or simply want to discuss your current claim, please feel free to contact us for a free consultation at (866) 363-3628 or at www.dilawgroup.com We handle cases nationwide.