Metropolitan Life Insurance coverage Firm—extra generally generally known as MetLife—is likely one of the world’s largest monetary companies firms. Whereas MetLife is often related to life insurance coverage and monetary companies, the corporate has a strong incapacity insurance coverage enterprise as properly.
For those who’ve just 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 choice, it is 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 will help you perceive your authorized choices. Maintain studying to study important steps it is best to take after a incapacity insurance coverage denial.
MetLife Has a Observe Report 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 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 1000’s of its shoppers’ pension claims. It needed to pay tons of of hundreds of thousands to shoppers whose claims have been misplaced, delayed, or in any other case mishandled.
For giant firms like MetLife, their main objective is revenue. They course of 1000’s of claims and slicing corners is extra widespread than any of us need to admit. Nonetheless, there are methods you may 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
Not like many different massive insurance coverage firms, MetLife at present doesn’t promote particular person incapacity insurance coverage insurance policies to personal people. Since September 2016, MetLife has solely provided group incapacity protection by means of worker profit packages.
Which means if in case you have incapacity insurance coverage by means of MetLife, your plan is sort of actually ruled by a federal regulation generally known as the Worker Retirement Revenue Safety Act of 1974, or ERISA for brief. You’ve gotten sure rights and protections beneath ERISA. Nonetheless, you additionally should comply with strict tips for the way and when you may attraction a incapacity denial or file a lawsuit, and what proof you’re allowed to incorporate.
The rest of this weblog put up will primarily concentrate on the MetLife appeals course of beneath ERISA.
For those who did buy a person incapacity insurance coverage coverage straight from MetLife (not by means of an employer) earlier than September 2016, and that coverage stays in pressure, a unique algorithm could apply to you. We’ll 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
You need to act rapidly as soon as your declare has been denied. Below ERISA, you solely have a restricted time to attraction, and also you need to guarantee that preliminary attraction is as complete as doable. You may solely get one likelihood so as to add proof to the file.
Learn Your Denial Letter Fastidiously
MetLife is legally required to offer two crucial items of knowledge of their denial letter:
- The particular motive they denied your declare. For instance, they could 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 tips. 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 may file a lawsuit in courtroom. You additionally may have a most of 180 days to file an attraction. That may sound like quite a bit, but it surely isn’t.
Request a Copy of Your Claims File
MetLife could have supplied this along with your denial letter—but when they didn’t, request it instantly. Your claims file ought to embody all the knowledge that MetLife used to make their dedication. This might embody 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 reliable—and if not, the extra proof you’ll want to offer to your attraction to achieve success.
Contact a Lengthy-Time period Incapacity Lawyer
ERISA appeals are extraordinarily dangerous to attempt to deal with by yourself. The stakes are excessive and errors may be pricey.
The denial letter may make it look like MetLife’s appeals course of is straightforward and simple. It isn’t. Extra seemingly 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 lawyer. The earlier you get an expert to assessment your case, the higher your probabilities of success.
Collect the Vital Proof
As soon as your lawyer critiques the denial letter, plan paperwork, and claims file—and determines you may have an excellent case—they are going to begin that can assist you collect the related proof. This may embody issues like:
- Extra 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, members of the family, and different people who’re educated about your bodily and psychological capabilities, earlier than and after you grew to become disabled
- Images, movies, journal entries, and different recordings of your day by day experiences and circumstances
- Every other proof your long-term incapacity lawyer may take into account related to your case
Make Certain Your Evidentiary Report 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 choice, you can not submit extra info, regardless of how necessary it’s to your case. Even when MetLife denies your attraction, and also you file a lawsuit, the courtroom will solely have the ability to assessment 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 will help you acquire and submit proof that helps your allegations and paperwork your disabilities.
File Your Administrative Attraction and Look ahead to a Response
After getting your proof collectively, your lawyer will enable you to put together and submit your attraction. This may embody all the brand new proof you’re including to the claims file. It is going to additionally embody an in depth attraction letter that outlines why, particularly, you disagree with MetLife’s dedication and consider your advantages needs to be accredited.
After you attraction, MetLife may have an preliminary deadline of 45 days to reply. This may be prolonged one time for a further 45 days, so you could possibly be ready nearly three months to search out out in case your attraction has been accepted.
Think about Authorized Motion If Your Attraction Is Denied
In case your declare is denied, and there are not any extra necessary administrative appeals you have to undergo, your remaining choice is to file a lawsuit in courtroom.
From right here, your case will seemingly be reviewed by a decide (not a jury) and, as famous above, the decide will solely have the ability to assessment the prevailing proof in your claims file.
Though no new proof may be added, your long-term incapacity lawyer will nonetheless have the ability to symbolize your pursuits in courtroom. They will put together written briefs, current oral arguments, and clarify and interpret proof within the file.
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 have been bought beforehand. When you have certainly one of these “grandfathered” insurance policies, it might be ruled by your state’s contract legal guidelines quite than ERISA.
Generally, policyholders with non-ERISA plans have extra choices relating to appeals. For instance, you might not be required to finish an administrative assessment earlier than submitting a lawsuit, and also you might be able to request a full jury trial.
As a result of every state has a novel set of contract legal guidelines, you’ll want to contact a long-term incapacity lawyer in your state as quickly as doable to start reviewing your authorized choices.
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Bryant Authorized Group: Incapacity Legal professionals Who Can Struggle for Your Rights
If MetLife just lately 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 shoppers assess their authorized choices, determine the proper procedures, “stack” their evidentiary file, and negotiate with the long-term incapacity firm.
To study extra about our strategy and the way we would have the option that can assist 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 temporary on-line kind.
