Dell & Schaefer ERISA Administrative Appeal Proves to MetLife that Client is Still Disabled and Claim Not Subject to Certain Policy Limitations

Dell & Schaefer is happy to report that a client of ours is back on claim and receiving Long Term Disability (LTD) Benefits once again from the Metropolitan Life Insurance Company. Our client contacted us after receiving a denial letter from MetLife dated June 26, 2014. Prior to this time, she had received LTD benefits with no issue for almost two years. Unfortunately for our client, MetLife incorrectly determined that our client’s main disabling condition was fibromyalgia. The Long Term Disability Policy governing our client’s claim is a policy she was covered under due to her employment at The ServiceMaster Company. This particular policy limited benefits to 24 months for certain disabling conditions which include “mental or nervous disorders” or “for disabilities due to neuromuscular, musculoskeletal or soft tissue disorder and chronic fatigue syndrome and related conditions.” After receiving MetLife’s June 26, 2014 denial letter, our client found us and quickly became a client of Dell & Schaefer.

MetLife’s Denial Letter

In its denial letter of June 26, 2014, MetLife stated that our client’s “current disabling diagnosis of fibromyalgia falls under the limited benefit provision” of the Plan and benefits are limited to 24 months to the date of July 15, 2014. MetLife’s denial letter also stated that its medical director “took into consideration (her) diagnoses of lupus, diabetes, diabetic neuropathy, shoulder pain, osteoarthritis and coronary artery disease and determined that the medical information did not support that (she) would be prevented from performing the duties of (her) sedentary occupation for these diagnoses.”

Administrative Appeal filed by Dell & Schaefer

As The ServiceMaster Company LTD Policy is governed by the Employee Retirement Income Security Act of 1974 (ERISA), 180 days was given for our client to file an administrative appeal. With the help of Disability Attorney Alexander Palamara of Dell & Schaefer, a timely appeal was filed. The appeal noted that MetLife’s denial was primarily based on an internal review by one of its own employees. As such, MetLife did not have any independent physicians examine our client nor did any independent physicians conduct a review of our client’s medical records. Instead MetLife merely relied upon a biased review of one of its own employees. Furthermore, the appeal focused on the tremendous amount of support by our client’s treating physicians who supported our client’s claim as well as the extensive objective documentation that proved that our client’s conditions beyond fibromyalgia were enough to satisfy the definition of disability in the policy.

Re-Approval for Long Term Disability Benefits

Within 90 days of the filing of the administrative appeal, our client was informed that MetLife had overturned its previous decision to deny our client’s continued claim for benefits. MetLife has found that our client is “unable to earn more than 80% of her predisability earnings at any gainful occupation for any employer in her local economy for which she is reasonably qualified taking into account her training, education and experience.”
Our client is aware that the fight will continue as MetLife can attempt to deny her claim at any point in the future. However, our client can rest assured that the Attorneys at Dell & Schaefer will continue to fight MetLife so that she continues to receive her monthly LTD benefits so that treatment can continue.

If you have been denied 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.

Read more about fibromyalgia and disability claims.

Questions About Hiring Us

Do you help MetLife claimants nationwide?

We represent MetLife clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a MetLife disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from MetLife. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by MetLife.

How do you help MetLife claimants?

Our lawyers help individuals that have either purchased a MetLife long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with MetLife:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Robert C.

After being denied initially, I searched our local area for an attorney who specialized in disability claims and found none. I spoke to a couple law firms that said they had “experts” in ERISA claims but after talking with them I determined they were no experts. I did a search on the internet and found Dell & Schaefer (Thank God.) After one phone call with Steve Jessup I knew that I had the attorney I was looking for. He had the “backbone” to stand up to the insurance company and was not the least bit afraid of going toe to toe with them. We won our appeal and have hired Steve to continue to represent me for help with the benefit distribution process. I highly recommend Steve and his staff.

***** 5 stars based on 202 reviews

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