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MetLife Long Term Disability Claims and Appeals

Metropolitan Life Insurance Company, or MetLife, is a popular issuer of short term and long term disability insurance.

If you need to file a disability claim with MetLife, the Maddox Firm can help. If you filed a disability claim with MetLife and it was denied, or if MetLife terminated your disability benefits, the Maddox Firm can help you appeal that decision. We have handled many MetLife claims and appeals, and we have successfully litigated against MetLife.

MetLife long term disability claims Building

MetLife Long Term Disability Insurance

MetLife is one of the largest life insurance companies in the world, with more than 90 million customers in over 60 countries. The company has a long history dating back to 1863, when it was founded as National Union Life and Limb Insurance Company. Later, the name was changed to the Metropolitan Life Insurance Company, and then it was shortened to MetLife. Today, MetLife is a global leader in the long term disability insurance and life insurance industries, offering a variety of policies and plans.

MetLife’s Definition of Disability

To successfully receive short term disability benefits or long term disability benefits, you must meet the definition of disability in the policy. Typically, an employer-provided MetLife disability policy defines disability as an inability to perform the duties of your own occupation – at least for the first 24 months. After that, the definition of disability likely changes to require that you demonstrate an inability to perform the duties of any occupation.

Some MetLife policies have different definitions of disability. For example, if you bought your own MetLife disability policy (as opposed to having it provided by your employer), you may have bought additional riders at the same time. In many policies bought by physicians and other independent contractors, we see additional riders. Some riders change definition of disability to only require you demonstrate an inability to perform the duties of your own occupation for the entirety of the policy period. Other riders add a residual or partial disability provision. Residual or partial disability riders may allow you continue to work if you can still perform some of the duties of your occupation or if you can still do part-time work. You

must also show that you have a loss of income due to the disability. Typically, the loss of income must be at least 20% of prior income. The benefit will be reduced for a partial disability or residual disability claim, but it will not be reduced to zero unless you do not have the required loss of earnings.

Reasons MetLife May Deny Your Long Term Disability Claim

MetLife may deny your long term disability claim for several reasons. Among those reasons are:

Lack of Consistent Treatment: You may have failed to maintain consistent treatment with a physician. Most MetLife policies require that you receive appropriate care from a physician who is appropriate to treat the condition causing the impairment. MetLife requires that you treat with a physician. Although you may also treat with an alternative medicine or other healing provider. Although it may be a burden to go to the doctor frequently, especially if there is little treatment or change in your condition, it is helpful to your claim that you maintain consistent, frequent treatment.

Pre-Existing Condition: You may suffer from a disability caused by a pre-existing condition. Most MetLife policies require that the disability be due to a new condition. Pre-existing conditions are usually defined as any condition that you received treatment for or consulted a doctor about, during the three months before the disability insurance began. That said, in many states, pre-existing condition limitations may only act as a temporary waiting period for benefits to begin. Check your state’s law to be sure.

Lack of Medical Records: MetLife may deny your disability claim if you fail to supply medical records that demonstrate disability. You may have difficulty getting your doctors to cooperate with requests for medical records. Or, you may find that your doctors’ medical records are not sufficiently detailed to provide support for your inability to perform you job. When treating with your doctor, be sure to describe all of your symptoms in detail, including any fatigue, pain, cognitive issues, or side effects of medication. Describe in detail for your doctor what exactly is preventing you from being able to do your job.

Lack of Objective Evidence: Depending on your condition and symptoms, MetLife may require that you submit objective evidence of disability. What is objective evidence is not easily defined, but in general, objective evidence is evidence that does not depend upon the "say-so" of the patient and cannot be faked. This may mean, for example, that if you suffer from cognitive issues, that you need to obtain a neuropsychological evaluation. Or, for example, if you suffer from an inability to sit for longer than a certain period of time, you may need to obtain a functional capacity evaluation. There are other tests that are specific to each set of conditions and symptoms. Deciding which test will help provide objective evidence is an important part of the process of filing a disability claim.

Surveillance: MetLife may conduct surveillance of you. Surveillance means that MetLife may hire someone to watch you when you leave your house to see if you do anything inconsistent with disability or inconsistent with what you have told MetLife. So, for example, if you have you’re your doctor that you cannot grocery shop, it is inconsistent to be videotaped carrying several bags of groceries. Generally speaking, this type of surveillance is unlikely. It happens, but not as often as you may fear. It would be very expensive to conduct surveillance on every person who files a disability claim. What is not expensive is conducting online searches for your activities. For this reason, it is likely that MetLife conducts online searches for almost every disability claimant. If you haven’t already, it is worthwhile to delete your online social media profiles or make them private. Even if you are not doing anything that is inconsistent with disability, MetLife may misinterpret the information available online.

What You Should Consider Supplying to MetLife with Your Claim or Appeal

MetLife long term disability claim form

MetLife may not ask for everything that it should have to be able to adequately evaluate your disability claim or appeal. For this reason, you need to make sure you do all you can do to supply that information. This is a list of some of the items you should consider submitting.

Personal Statement: Providing personal information, in addition to the information requested on the MetLife disability application, can help you prove that you meet the definition of disability. You should consider providing information regarding your work history, the history of your conditions and symptoms, the specific duties that you can no longer perform and why, which activities of daily living you can no longer perform (can you still cook, clean, dress yourself, balance a checkbook, etc.), and what your plans for the future are.

Statements of Family Members, Friends, and Coworkers: The statements of other people in your life can help to provide some context and further support for your work history and the history of your conditions and symptoms. The statements can also help humanize you in the mind of the MetLife reviewers. The subject matters can be similar to the subject matters of your personal statement to the extent that is appropriate. Ask your people to be specific about what they know. Anecdotes help.

Testing Evidence: If imaging such as an MRI or an X-ray is appropriate, make sure those studies are submitted to MetLife. If your disability relates to your cognitive abilities, consider having a neuropsychological evaluation submitted to MetLife. If your disability is physical, consider having a functional capacity evaluation submitted to MetLife.

Report of Your Doctor: Your doctor’s notes may not be as detailed as they should be. Or, your doctor's notes may not address your disability to the extent that would be helpful for your MetLife disability claim application or appeal. Ask your doctor if they would be willing to supply a report detailing your medical history, the evidence reviewed that is supportive of your disability, what activities of daily living you can no longer perform (if any), and what duties of your work you can no longer perform.

Vocational Evidence: It is important for MetLife to have an understanding of what duties were required by your job, what duties you can no longer perform, and what duties you are qualified to do. You may consider obtaining a vocational report from a vocational expert outlining each of these areas. Or it may be enough to submit a resume, a job description, a personal statement describing your job, and/or an employer or coworker statement describing your job.

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We always recommend speaking with a trusted attorney before filing or appealing a MetLife short or long term disability insurance claim. Whether you are looking for assistance in navigating the claims process, appealing a MetLife claim denial, or litigating a final adverse decision, The Maddox Firm can help. The team at The Maddox Firm will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.


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