How Do I Fight a MetLife Disability Denial?

If you applied for long-term disability benefits but were denied, don’t lose hope—a MetLife disability denial isn’t the end of the road. Even after being denied your disability benefits, there are still steps you can take to receive your benefits.

All long-term disability (LTD) policies have at least one level of administrative appeal that claimants who have been denied can pursue, and some LTD policies even allow for two levels of administrative appeals. It is not unusual for people to receive their benefits through this appeals process—in fact, it’s quite common.

Is the Appeals Process Worth It?

Understandably, facing the appeals process can seem bleak since you are appealing to the same company that issued your benefits denial the first time. However, an appeal never goes to the same person who issued the first denial, but instead will be evaluated by an entirely different claim unit. The second claim unit may very well disagree with the initial decision, especially if new evidence has been included to strengthen the claim upon appeal.

Federal law requires that all administrative appeals first be exhausted in an LTD group plan prior to pursuing any litigation. Even with an individual plan, which does not fall under this federal law, exhausting administrative appeals will still provide the opportunity to have your MetLife disability denial overturned without needing to file a lawsuit.

How Do I Prepare for an Appeal?

Preparing to appeal a MetLife disability denial, or the denial of any private long-term disability insurance for that matter, involves two major components:

• Reading and fully understanding your denial letter, particularly why you were denied and what your case was lacking
• Ensuring you have as much favorable evidence as possible on the administrative record

Your denial letter is the most important piece of insight into what your insurance company wants from you. It is required to state why your claim was denied, and provide instructions explaining how to file an appeal. Fully understanding the reason your claim was denied will help you prepare evidence for the appeal. For instance, if your insurance company said your claim was denied because there wasn’t enough medical documentation of your condition, you may consider submitting medical evidence such as X-rays or MRIs.

Your denial letter will also outline how to go about filing an appeal, including important things like deadlines and other requirements. It is important to follow these guidelines to the letter, giving your insurance company no reason to deny your claim. Federal law requires that insurance companies give at least 60 days for a claimant to file an appeal, but some LTD policies allow even more time.

Can I File a Lawsuit?

If you have exhausted all administrative appeals, you can turn to litigation. However, under the Employee Retirement Income Security Act (ERISA), no new evidence can be added to your case for consideration in a lawsuit after the appeals have gone through, so it’s essential that you use your appeal or appeals to add as much favorable evidence to your case as possible.

It may also help to have an experienced attorney at your side to craft your appeal letter, determine what evidence to include, and what experts in the area might be able to help your case—regardless of whether you pursue litigation.