Disability insurance is a smart option for anyone looking to hedge against uncertainty. Available for both short-term and long-term disabilities, this type of policy will provide benefits in the event that you are unable to work due to a physical or mental health condition. Unfortunately, claims for disability benefits are often denied — including by mega insurance provider MetLife.
Globally, MetLife is one of the largest providers of employee benefits, insurance, and annuities. Founded in 1868, it now ranks as one of the largest corporations by total revenue, at number 44 in the 2019 Fortune 500 list. Last year, MetLife had total revenues of $67.9 billion and profits of $5.1 billion.
Despite the enormous profits posted by MetLife, the company has a history of unfairly denying or terminating long-term disability (LTD) benefits for its insureds. If MetLife has wrongfully denied your disability benefits claim, a Philadelphia long-term disability insurance attorney can help.
Why MetLife May Deny a Disability Claim
LTD insurance is a critical part of your financial planning. LTD insurance is offered by many employers as part of a group benefits plan, but it can also be purchased by individuals. If you are approved for LTD benefits, you will receive between 50 and 60% of your salary while you are unable to work due to a disability. Depending on policy terms, the benefit period may be as short as 24 months or up to retirement age.
Of course, you can only receive LTD benefits if the insurance company approves your claim. This is where companies like MetLife often act unfairly, using a number of common denial tactics to avoid paying you what you are owed. Remember that MetLife is a business — and it didn’t get to number 44 on the Fortune 500 list by approving all claims for disability benefits.
There are a number of strategies that MetLife (and other long-term disability insurance companies) use to deny or terminate claims. This may include:
- Claiming that there are no objective findings to support your disability, particularly in cases where you are experiencing subjective symptoms that are not easily quantified (such as pain, fatigue, or anxiety).
- Arguing that the medical evidence to support your diagnosis is insufficient
- Finding that you do not meet the policy’s definition of disabled
- Using surveillance to find evidence that they can use to support an argument that you are not disabled or that you are able to work
- Stating that you missed a deadline
- Terminating coverage after 24 months for mental health issues or certain other disabilities
- Using a different definition of disability after 24 months (from “own occupation” to “any occupation”)
In many of these situations, working with a Philadelphia long-term disability insurance attorney may help you avoid a wrongful denial or termination of benefits.
In 2008, the United States Supreme Court decided a critical case involving MetLife’s denial of benefits to a woman who was unable to work due to a disability. In Metropolitan Life Ins. Co. v. Glenn, the company initially approved LTD benefits to a policyholder named Wanda Glenn. MetLife then encouraged Ms. Glenn to seek Social Security Disability Insurance (SSDI) benefits. After she was approved for SSDI, in part due to MetLife’s own determination that she was disabled, MetLife terminated Ms. Glenn’s benefits on the basis that she was no longer disabled.
Under the Employee Retirement Income Security Act of 1974 (ERISA), insurance companies who offer certain group disability plans are required to follow specific rules and procedures. Courts will generally uphold denials of benefits unless the insurer abused its discretion. When an insurance company has a conflict of interest, a denial of benefits may be deemed illegal.
The Supreme Court found that there was strong evidence that MetLife had a conflict of interest in Ms. Glenn’s case, as an entity that both decides whether she has a disability and pays the claim if she is disabled. In other words, MetLife could not fairly decide whether Ms. Glenn was disabled because it had a financial motivation to find that she was not disabled. When MetLife denied Ms. Glenn’s disability benefits after she was deemed eligible for SSDI, it abused its discretion. MetLife was then required to pay LTD benefits to Ms. Glenn.
This case is just one example of the ways in which insurance companies like MetLife may engage in unfair behavior in order to deny or terminate LTD benefits. If your insurance company has wrongfully denied or terminated your benefits, you may be able to file an appeal.
Appealing a Metlife Disability Claim Denial
There are two primary ways that you can appeal a denial of disability benefits. The type of appeal that you can file will depend on whether your disability insurance policy is covered by ERISA. Generally, if your insurance policy is provided by your employer, then it will fall under ERISA. If you purchased an individual plan, you can appeal a denial outside of ERISA.
ERISA provides requires that insurance companies follow specific procedures when denying or terminating a claim. This includes providing a notice that details why your claim was denied, the basis for the denial under the policy, a notice of your rights, a copy of the rules used in denying your claim, and a description of the appeals process. Under federal law, you must file an appeal directly with the insurer before pursuing further legal claims.
If the insurance company denies your appeal, then you may be able to file a lawsuit against it in federal court. A lawyer can work with you to file the initial appeal and represent you in a lawsuit against your insurance company. Working with a Philadelphia long-term disability benefits attorney can increase the likelihood of a successful appeal of the denial or termination.
For plans that are not covered by ERISA, you will typically have a specified period of time in which to file an appeal of a denial or termination of benefits. If your appeal is denied, then you may file a lawsuit against the insurer in state court. These lawsuits are often based on an argument that the insurance company acted in bad faith in denying your claim or terminating your benefits.
Did MetLife Deny Your Disability Claim? We Can Help.
Like other insurance companies, MetLife is notorious for unfairly denying claims for disability benefits. If you have experienced a wrongful denial or termination of your disability benefits, our firm can work with you to file an appeal and, if necessary, a lawsuit.
Bross & Frankel represents clients in both Pennsylvania and New Jersey who are seeking disability benefits from their insurance companies. With almost 100 years of combined experience, our legal professionals are well-equipped to handle even the most complex LTD denial cases. To learn more or to schedule a free claim review with a Philadelphia long-term disability insurance attorney, contact our office today at 856-210-3345, or online.