Dell & Schaefer Successfully Appeals Metlife Denial of Benefits to Veteran

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.

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, GoToMeeting.com 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   *****

Craig (California)

Cesar and Michal helped me through my case against Prudential. That only touches the surface. I suffered a bad injury which made me a challenge as I often didn’t recall what was said and to whom.

Cesar took the leap of faith to help me but he didn’t treat me like a client but more as if I was part of your family. I don’t know how you were able to get transform the team to have such a great attitude but by far I must say I am treated well from the moment I called, retained your firm it helped me through the minute I faced IME’s. Cesar demonstrates empathy and cares for his clients. I know that I made the right decision to select your firm and am fortunate that firms such as yours are around to help go up against big companies.

I truly am happy to send you a note to advise of my complete satisfaction.

The first and most important matter you have at hand is to take care of your health and let your retained lawyers handle the information needed to not only be approved for long term disability but also to make sure that your claim is managed for the duration of your disability. The disability is a matter that may last a lifetime.

A thorough online yelp review was held prior to conversations with Cesar Gavidia Esq. and Michal Mizrahi from the firm of Dell & Schaefer. I decided to retain them to handle my disability claim. The law-firm has an elaborate web page that demonstrates their ability to go up against all the largest insurance with a stellar track record.

The ERISA law is complex and if you decide to battle the insurance company without representation the odds will be stacked against you. An insurance company has one goal alone and that is to generate profits. The representation of Cesar Gavidia Esq. and Michal Mizrahi were responsible for the successful appeal and approval of my case.

An insurance company typically will deny or delay the claim as the penalty for denial or delay is non-existent. In my case, I was prepared with retained council Cesar Gavidia Esq and Michal Mizrahi who prepared and submitted the ERISA appeal. The document was complete and included information to demonstrate that I was disabled and overturned a previous denial from Prudential.

I’m not only happy to say that I picked the right firm but that I have developed a trusting relationship with combination of Cesar Gavidia Esq. and Michal Mizrahi from the firm of Dell & Schaefer.

Cesar Gavidia Esq. or Michal Mizrahi will pick up calls and take the time to explain what is being done by the insurance company or return the call in a timely basis if they were busy. This was after I had signed to be represented.

I never met Cesar Gavidia Esq. or Michal Mizrahi in person but I consider them my friends versus just attorneys that have been hired.

***** 5 stars based on 202 reviews

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