The dictionary defines insurance as something “providing protection against a possible eventuality.” Some forms of insurance are required—like car and homeowners insurance if you own a car or a house. Other kinds of insurance are not mandatory, but you can’t really live without them—such as health, vision, and dental if you’re lucky enough to have access to them. Still other options provide policyholders with extra peace of mind. Long-term disability (LTD) insurance falls into this final category.
If you have an LTD policy as an employee benefit—whether you pay the premiums or your employer does—you are counting on the coverage to help if you cannot work due to a serious injury or illness. As with any insurance, when you file an LTD claim, it’s because the “possible eventuality” has occurred, and you need money to pay bills. When you are denied, it can be devastating.
What to Do When MetLife Denies Your LTD Claim
Before you file a long-term disability claim with MetLife, make sure your condition meets the criteria set forth in the policy. Also, make sure to submit a complete claim, including medical evidence and whatever else is required by MetLife. If you have done all of that and still receive a denial letter, your first step should be to carefully review the letter to discover why you were denied. The denial letter should provide an explanation, whether it is valid or not. This important document should:
- Give the main reasons your claim was denied. Your claim cannot be denied for no reason. The denial letter should tell you why you were denied. Possible reasons for denial include missing a deadline, not meeting the policy's terms, insufficient evidence of disability, application errors, or suspicion of fraud.
- Summarize the evidence reviewed when deciding. The letter should outline the evidence used to deny your claim. This will help you understand if evidence was missing or misrepresented.
- Reveal who reviewed the claim and evidence. This could be an in-house nurse, a non-medical reviewer, or a doctor hired as a consulting medical expert.
- State what evidence is needed. The letter should list the medical evidence that would have been necessary to approve the claim.
- Inform you of your right to appeal. Under ERISA law, the letter should state you can appeal the decision and give you a deadline.
Your MetLife denial letter should provide enough information to determine whether you have grounds for an appeal. Still, it will not be easy for you to make this determination on your own.
As an ERISA Attorney, I Can Help
Employer-sponsored long-term disability insurance policies are governed by the Employee Retirement Income Security Act (ERISA), which lays out a complicated set of rules for appealing denials. If you received a denial letter from MetLife, or any other insurance company, call me for a free review of your denial letter. After I review the letter, I can tell you if I can help you with an appeal. If there are grounds for an appeal, and if you want to work with me, I will request your complete administrative file from the insurance company to build an appeal. Appealing an LTD denial is not easy, but I will gather the evidence necessary to draft a detailed appeal letter and sue if necessary.
I understand the frustration of a denied LTD benefits claim. Call the Monast Law Office to discuss the possibility of filing an appeal. We'll consider your claim and let you know if we can help you navigate the difficult ERISA process.