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Dell & Schaefer Successfully Appeals Metlife Denial of Benefits to Veteran

Attorney Victor PeñaAuthor: Attorney Victor Peña

Mr. A contacted our firm after being denied benefits by his employer’s group disability carrier, MetLife. He had been working as a supervisor for a large manufacturer of heavy duty automotive components. His job required him to perform prolonged physical activities like climbing, kneeling, standing, pulling grasping, lifting and working with various tools.

He was suffering from a long list of medical conditions including both physical conditions and mental health conditions and having served in the military for some time many of his conditions were service connected.
Over time, his conditions greatly diminished his capacity to perform his occupation effectively and he was forced to file for disability benefits.

The Veterans Administration approved his disability claim for service connected conditions and the SSA immediately approved his disability claim. However, when he applied for benefits with his employer’s group disability carrier, MetLife, he encountered some trouble.

During the initial application, Mr. A included all of his medical conditions including PTSD, back injuries, knee injuries, carpal tunnel and several other conditions.

After filing his claim, MetLife concluded that his medical records did not support a functional impairment that would prevent him from working in his own occupation from any employer in his local economy.

Before finding us, our now client retained an attorney from another law firm to handle the appeal on his claim. Unfortunately, MetLife denied the appeal but this time finding that there was support for functional impairment but that an exclusion in the policy applied to his claim. Since his psychiatric conditions were service connected, a war exclusion applied and no benefits were payable.

At that point, his attorney washed his hands of the claim which led our now client to find another attorney.

Given that they had issued a denial for a different reason than the first denial MetLife allowed another appeal but with the caveat that the appeal review would be limited to reviewing the psychiatric conditions that were denied under the war exclusion.

Despite the difficulty in the claim we took on his case.

After reviewing the claim file and medical records it became apparent that MetLife’s decision was wrong. While MetLife had classified his mental health conditions as the primary disabling conditions there was a substantial amount of information supporting disability from a physical standpoint.

During his service in both Iraq and Afghanistan, he suffered several injuries and the appeal became a matter of combing through the medical records to determine which medical conditions would fall outside the scope of the war exclusion.

We also set our client up to undergo an FCE to ensure that MetLife would not fall back on their common argument that there was no objective medical evidence.

After submitting the appeal, MetLife agreed to review all the information we submitted. Not long after, we received a letter overturning the denial.

Attorney Peña continues to represent Mr. A to best ensure that MetLife will not terminate his benefits. Feel free to call our disability attorneys for a free consultation if you have a similar claim or with questions on any matter relevant to your disability claim.