Our client previously worked as a Contracts Officer for the Miami Dade County School District. As a County Employee, our client was covered under both a Short Term Disability Policy and a Long Term Disability Policy that provided disability benefits if the client was unable to work at her own occupation. Unfortunately for our client, she was forced to apply for such benefits in September of 2012 as she suffered from Relapsing and Remitting Multiple Sclerosis among other associated and unassociated conditions.
Unfortunately for our client, MetLife denied our client’s claim from the beginning. In its first denial letter of December 14, 2012, MetLife acknowledged her condition but stated that the “medical documentation received in support of (her) claim does not demonstrate how (she is) precluded from performing the essential functions of (her) occupation as a Contracts Officer.” With the help of Attorney Alexander Palamara of Dell & Schaefer, an administrative appeal challenging MetLife’s initial determination was timely filed.
Partial Approval for Short Term Disability Benefits
After the filing of the administrative appeal challenging MetLife’s decision to deny our client’s claim, MetLife only decided to find our client disabled from September 10, 2012 through December 28, 2012. Therefore MetLife upheld its decision to deny benefits from December 28, 2013 through March 25, 2013, the end of the Short Term Disability time period. In support of that decision, MetLife relied upon an “independent” paper review and an internal review to conclude that “there was no clinical evidence substantiating a continuous impairment that would have precluded (our client’s) ability to perform her occupation beyond December 28, 2012 through March 25, 2013.” Thus MetLife was concluding that our client’s Multiple Sclerosis only limited her for a few months and that she was able to return to work full time as a Contracts Officer. We disagreed with this assessment and filed an additional appeal.
Social Security Administration Approves Client for SSDI Benefits
In addition to our arguments and contentions that our client was unable to perform her duties of her occupation, the Social Security Administration agreed when it approved our client’s claim for Social Security Disability Income Benefits. Additionally, a Functional Capacity Evaluation was also very supportive of our client’s claims, as well as overwhelming support of her treating physicians.
Decision to Deny Finally Overturned by MetLife
After two appeals and thousands of pages of medical records, MetLife finally agreed that our client was disabled for the full time period of the Short Term Disability Claim from September 2012 until March 24, 2013. The Full Benefit for STD was eventually paid in early December 2014, a little over 20 months after it should have been paid.
After the STD claim was approved, Attorney Alexander Palamara of Dell & Schaefer again reiterated his request that MetLife review and approve his client’s claim for Long Term Disability (LTD) Benefits. By way of a letter dated December 19, 2014, MetLife finally saw the errors of its ways and approved our client’s claim for LTD benefits and mailed a big check in late December 2014. Although our client is relieved to have finally been approved for LTD benefits and she is excited to receive the benefit check, it unfortunately took over 2 years for MetLife to see the Light. The undue stress and monetary strain has taken a toll on our client. Such stress has only increased her symptoms and flareups of her disease. The client can, however, be reassured that the Attorneys at Dell & Schaefer will continue to fight MetLife so that she can rest assured that her claim will continue.
If you have been denied Short Term or Long Term Disability Benefits by MetLife or any other insurance provider, please do not hesitate to contact the Attorneys at Dell & Schafer for a free consultation.
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