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MetLife Disability Claims Lawyer

CaveyLaw.com > Disability Insurance Companies > MetLife Disability Claims Lawyer

MetLife Disability Claims Lawyer

You bought your Metropolitan Life (MetLife) disability insurance policy with the promise that MetLife would be there for you and your family if you became disabled and unable to work.  You thought you were buying financial peace of mind!  Not with MetLife who I personally think are one of the worst disability carriers in the United States.

MetLife: A Brief History

Metropolitan Life Insurance Company is better known as MetLife. It is among the world’s largest providers of insurance and employee benefit programs. MetLife offers both individual disability insurance and group disability insurance as part of employee benefit packages.      

 

It was heavily involved in mortgage servicing and the foreclosure business and in 2012 failed the Federal Reserve’s Comprehensive Capital Analysis and Review stress test. The test was intended to predict the potential failure of a company during a financial recession.  It’s attempt to “escape the too big to fail regulation was not successful despite its attempt to sell it banking and mortgage servicing units in an attempt to get around the 2010 Dodd-Frank law. Ultimately, MetLife paid fines and settled multiple lawsuits over junk fax operations that generated leads for their life insurance products.

MetLife Pays Peanuts

 

Are you a fan of Peanuts and Snoopy? MetLife paid over 12 million dollars per year to license the use of the character until October 2016. Why? According to Chief marketing officer Esther Lee, MetLife wanted to make the company “more friendly and approachable during a time when insurance companies were seen as cold and distant.”

 

But, as an attorney who regularly files appeals of MetLife denials and sues MetLife for wrongful denials or termination, I think MetLife is like Lucy van Pelt. You remember Lucy, who pulled the football away just as Charlie Brown got ready to kick it, humiliating Charlie Brown.

 

Instead of pulling the football away, MetLife pulls the financial rug and safety net from under its disability insurance policyholders. Don’t let MetLife act like Lucy Van Pelt.

 

MetLife will:

 

  • Use in-house nurses to review medical records and reach medical conclusions about the policy-holders restrictions and limitations even though those nurses may have no training in or qualifications to render any opinions about the policyholder’s medical conditions,
  • Use biased medical peer review providers to create medical justifications for a claim’s denial,
  • Use surveillance to discredit the policyholder’s complaints,
  • Use in-house vocational evaluators to misclassify the policy holder’s occupation, perform questionable transferrable skills analysis and misinterpret the wages of and availability of other occupations it will claim the policyholder can do to justify the denial or termination of benefits.

 

MetLife plays games with initial applications and makes endless and multiple requests for medical, financial, and vocational information before it figures out a way to deny benefits. This delay and denial strategy drains the policy holder’s bank accounts as they try to stay financially afloat. It is their business model.

 

MetLife uses “liar for hire” doctors who give them the ammunition it needs to justify a claim’s denial or termination. MetLife rarely tells a denied policyholder the real reasons the claim was denied. Worse yet, MetLife claims by an experienced lawyer, like myself, who battles MetLife daily.

 

Don’t think that MetLife doesn’t play the claims delay, denial, or termination game with individual disability policies. They are and the policy benefits at stake are often much high so there is much more to lose if you aren’t represented by a MetLife individual disability attorney.

 

A MetLife Disability Attorney Will Help You with Your MetLife Claim By:

 

  • Reviewing your policy,
  • Reviewing your medical records,
  • Create a pre-claim strategy to get your benefits on the initial application,
  • Appeal a wrongful denial or termination by writing an appeal letter 25 to 60 pages long that is the trial of your case and goes to MetLife inbox,
  • Protect you from aggressive claims handling by MetLife, including the delay game, the-we need more information-game, we want to take your statement game or we want to have you under an independent medical examination or FCE,
  • Aggressively litigating your case, if need be.

 

Make no mistake about it, MetLife plays games with initial applications and makes endless and multiple requests for medical, financial, and vocational information before it figures out a way to deny benefits. This delay and denial strategy drains your bank accounts as you try to stay financially afloat.

 

MetLife uses “liar for hire” doctors who give MetLife the ammunition it needs to justify a claim’s denial or termination. MetLife rarely tells a denied policyholder, like you, the real reasons the claim was denied. Worse yet, MetLife fails to fully explain what you need to submit to successfully win an appeal.

 

That’s why it is crucial that you be represented at both the initial application and appeal stages of a MetLife claim by an experienced lawyer, like me, who battles MetLife daily.

 

Don’t Face MetLife On Your Own

 

Some MetLife policyholders make the mistake of going it alone and they pay dearly for “doing it yourself.” Once the appeals process is exhausted (and that really means you are exhausted by the endless requests for information and battling with MetLife), the only recourse is to file a lawsuit. If you purchased your insurance through your employer, the policy is most likely governed by the Employee Retirement Security Act or ERISA.

 

Despite its name, the ERISA statute and regulations are NOT policyholder friendly.  You CANNOT add anything to the claims file after the last denial so all the Federal judge gets to see is what is in MetLife’s file which is stuffed with medical and vocational opinions that are favorable to MetLife. You didn’t know enough to get the claims file when you appealed, didn’t know enough to add medical, vocational or lay evidence to the file, or didn’t make the right arguments, you have all but destroyed your case.

 

An appeal of a denied MetLife claim is the trial of your case. Taking on a tough insurance company like MetLife is an endeavor for a specialist. A federal judge will give MetLife the benefit of the doubt because your MetLife policy requires you to prove they are wrong and not the other way around. You owe it to yourself and your family to have an experienced disability attorney, like me, take on MetLife. After all, this is about getting the disability benefits you deserve and you paid for.

 

Some policyholders have bought their own disability policy through an agent and that is known as an individual disability insurance policy. The game is the same but the playing field is more level because any claims denial can be challenged in state court which is a friendlier place to be if you have to sue MetLife.

 

Don’t think that MetLife isn’t playing the claims delay, denial, or termination game with individual disability policies. They are, and the policy benefits at stake are high. There is much more to lose if you aren’t represented by a MetLife individual disability lawyer.

The Three Types of Disability Policies Offered By MetLife:  Group ERISA Disability, Group Non-ERISA Disability Policies and Individual Disability (ID) Policies

 

The type of policy that you have will determine your rights and whether you are playing on a level playing field.

 

Group ERISA Disability Insurance

 

MetLife offers disability policies through employers which are governed by ERISA. A MetLife ERISA policy generally has the following:

  • strict definitions of disability and occupation,
  • limitations on how long payment will be made for mental conditions or subjective conditions like  headaches, pain, fibromyalgia or chronic fatigue,
  • “other income” provisions that allow for a dollar for dollar reduction for the receipt of Social Security disability benefits, workers’ compensation benefits, and personal injury settlements, and
  • A “golden handcuff” on a judge that only allows for a claims denial or termination reversal if MetLife’s decision is “arbitrary and capricious.”

 

Group Non-ERISA Disability Insurance

 

However, a group plan offered by a church plan, such as the Catholic Church, or by a municipal employer like the City of Baltimore, Baltimore County, or the State of Maryland is NOT generally covered by ERISA. The policy terms are much like those of an ERISA plan but there is one CRUCIAL difference. A claim’s denial or termination can be challenged in state court and new evidence can be submitted at trial.

State law courts are a much friendlier place for a policyholder than Federal court. You are entitled to a jury trial in a state law claim and not some Federal judge just making a decision based on MetLife’s file stuffed full of things that are unfavorable for you!

 

Individual Disability (ID) Insurance

 

Without a doubt, the best and most expensive policy is a private individual disability policy known as an ID policy. The policy terms and coverage are broader and more generous. But that means a high monthly premium and a lot of financial exposure that MetLife has if you become disabled.

 

It isn’t uncommon for MetLife to invoke a pre-existing exclusion or a medical condition policy rider right out of the box as a way to justify a denial of the claim from the beginning of the claim. That is just one reason why it is so important for a policyholder to contact me BEFORE they stop working and apply for benefits.

 

Let say, for example, you are a dentist who has a policy that excludes any claim for disability as a result of carpal tunnel syndrome but you now can’t work because of a herniated cervical disc. The symptoms of carpal tunnel syndrome can mimic those of a herniated cervical disc that causes tingling, numbness, and weakness of the hand.

 

You can bet that MetLife will be looking for a way to say that you are disabled as a result of carpal tunnel syndrome and not a herniated cervical disc. Do you know what your medical records say about your medical history, your carpal tunnel complaints, how your complaints are different because of the herniated cervical disc, or how the impact on your practice is different than your carpal tunnel symptoms?

MetLife fights an individual disability claim as hard, if not harder than an ERISA claim and costly mistakes can be made at the initial application and appeal stages of a case.

 

MetLife Long Term Disability Claims and Social Security Benefits

 

You need to understand that MetLife requires you to apply for Social Security Disability benefits as part of your Long Term Disability claim.

 

While they try to explain the benefits as to why you should apply for Social Security Disability benefits, they really don’t make it clear that your Long Term Disability benefits will be reduced by MetLife once you’ve received Social Security Disability benefits.

 

They also recommend that you call MetLife to discuss hiring an attorney to represent you in the Social Security Disability case, be sure that they will refer you to an attorney or claims representative that has MetLife’s interests at heart and not yours!

 

At The Law Offices of Nancy L. Cavey, we believe that you should have a private attorney represent you for your Social Security Disability and Long Term Disability case to make sure that your benefits are properly protected.

 

MetLife LTD Claim Forms

 

If you purchased long-term disability benefits and your doctor has told you that you are unable to work, you should file a long-term disability claim form.

 

There is no uniform disability form, but carriers like MetLife will use an individual disability claim and statement, individual long-term disability assessment, attending physician forms, and behavioral assessment as part of the disability claims process.

 

It’s never surprising when MetLife denies a long-term disability claim because carriers like MetLife are always looking for a reason to deny your long-term disability claim. The reasons for denial can start with how you have filled out your long-term disability application or what your physician says on the attending physician claim.

 

You should remember that MetLife went to the United States Supreme Court in the case of Metlife vs. Glenn arguing that they didn’t have any conflict of interest in making the claim’s determination when they were both the administrator of a long-term disability claim and the payer of a long-term disability claim. It sounds obvious that they would have a conflict of interest. If your claim is denied, it is crucial that you know how to accurately develop that conflict of interest so that you get the long-term disability benefits you are entitled to.

 

MetLife claim disability attorney Nancy Cavey can help cut through the red tape and fight for your benefits no matter where you live in the United States. She has written a number of must-do books about the long-term disability policies and games that long-term disability carriers play. If you have difficulty getting these forms from MetLife, or completing the same, you should contact The Law Office of Nancy L. Cavey today.