Disability lawsuit against MetLife alleges insurance company refuses to pay disabled claimant

Insurer states client should have taken strong anti-psychotic drugs during pregnancy and while breastfeeding, claims she is too “logical” and “organized” to receive benefits.

The Metropolitan Life Insurance Company, known as MetLife (NYSE: MET), is being sued in United States District Court, Southern District of Florida, for refusing to honor its contractual obligation to pay long term disability insurance benefits to a psychologically impaired woman.

According to the lawsuit, filed by the nationwide disability insurance law firm of Dell and Schafer, MetLife claims that despite the woman’s medical diagnosis of Major Depressive Disorder, Anxiety, Panic Attacks, Social Isolation, Phobias, Chest Pains, and Limb Numbness, that she is capable of performing her job as an information technology (IT) specialist for a manufacturer of dangerous chemicals.

Incredibly, MetLife claims that the client caused her own mental health issues by refusing to take potentially dangerous medication while pregnant and later breast feeding. Additionally, MetLife stated in its denial letter that the insurance company’s hired medical consultant states the woman is capable of working because she provided documents and records demanded by MetLife in a coherent manner.

“Your correspondence and communication with MetLife is neatly prepared and logical, well organized, and detailed. (Our) consultant indicated that this demonstrates that you have retained normal cognitive and organizational abilities which require consideration, focus, and fluent expression.”

Meanwhile, the client has faced foreclosure on her home, and continues to receive treatment for her psychological issues. She was forced to retain the counsel of attorneys to receive the benefits contractually owed to her under the terms of her long term disability policy.

The refusal by MetLife violates terms of her MetLife disability policy and the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.

The client seeks MetLife to pay all Long Term Disability Benefits due to her under the terms of The Plan, plus all other damages, interest, and attorney’s fees. She also seeks all damages in the form of full, past, present, and future disability insurance benefits, interests, and attorney’s fees due to her pursuant to 29 U.S.C. 1132(g)(1).

The lawsuit was filed in United States District Court, Southern District of Florida, Fort Lauderdale Division.

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There are 10 comments

  • Danny,

    When was your appeal submitted? MetLife would only have 45 days to render a decision, with the possibility or requesting a 45 day extension- so roughly a 90 day period without considering issues of tolling pending receipt of information.

    Stephen JessupJan 15, 2016  #10

  • Metlife is absolutely a big scam company. I was on short-term disability from Aug 20th, 2015 until Oct 1st, 2015 and then on Oct 2nd, 2015 they denied my extension of my disability because they said there wasn’t enough medical evidence to support the disability??? So now, I’m in the middle of an appeal for my Short-Term Disability for Trigeminal Neuralgia and a-typical face pain which causes me to be unable to wear a hard-hat which is something I have to do 100% of the time with my job. I’ve been out of work since Nov 16th 2015. One of their representatives told me 2 weeks ago on a Monday that my claim would be reviewed and done by that Friday, because everything they needed was submitted. I was also told that MetLife’s internal doctor had already said there was enough medical evidence to approve the disability. Needless to say the appeals specialist I spoke with this morning said that no one should’ve revealed to me that the doctor said there was enough evidence until the final account review was done. I’ve done everything they have asked of me and my doctors. I told her that my doctors submitted the SAME information about my diagnosis 2 weeks ago because that is what they requested AGAIN and nothing has changed with my current situation. I said if the internal doctor has already said yes there is enough medical evidence to support my claim then what is the problem? She said, you shouldn’t have been told that until the final review is done, because the doctor could change his mind??? I’m a 17 year disabled Marine Corps veteran who was diagnosed with major depression, panic attacks, anxiety, and PTSD from combat. I’m disabled from working at my company and haven’t been paid since Nov 19th and keep getting the run around by this company! I have a wife and 2 kids and we are going downhill fast by not receiving a paycheck for almost 2 months! My medical issues are getting worse because of the stress this company is putting me through, it’s ridiculous and unprofessional to put people through this unnecessary stress!

    Danny DJan 14, 2016  #9

  • Ericka,

    I assume your claim is for Short Term Disability at this time. If so, I would recommend you contact your HR department. Most STD claims are administered by the insurance carrier but funded by your employer. If that is the case your employer is responsible for cutting the check- and contacting HR could speed that process up for you.

    Stephen JessupNov 15, 2015  #8

  • MetLife approve my disability payments to begin on Nov 2. which is after the one week waiting period required from my job. Well, it’s Nov 14 and I have yet to receive a payment. I keep getting told it’s on the way but when I log on their website, I don’t see a payment history.

    ErickaNov 14, 2015  #7

  • Jim,

    If your girlfriend attends to pursue litigation please feel free to have her contact our office to discuss how we may be able to assist her.

    Stephen JessupOct 26, 2015  #6

  • For over 20 years my girlfriend paid long term disability premiums to her employer, Kroger company. Kroger paid Met Life to manage this long term disability along with the companies short term disability program. My girlfriend had to quit working due to fibro, arthritis and other ailments. Her primary care doctor put her on sick leave where she has been for over 6 months. During this time Met Life, who manages the program, has denied her short term (And without approval for short term, denies long term) disability. Guess who has to pay if Met Life where to decree that she is disabled? That’s right, Met Life.

    Met kept asking for one paper after another in what I determined was a stall tactic to cause my girlfriend to run out of money forcing her to return to work. This never happened, she IS in a bad way so I paid her bills. I figured once Met Life runs it’s game of denial and they see she is disabled they will come through with the payments. NOPE. They said final appeal, not going to pay. Now here is the kicker, her own companies policy says you qualify if you cannot perform your duties to 80% of expectations. The doctor said she cannot work more than a total of 4 hours a day, clearly 50% of capacity and yet Met Life used their own doctors to say that her doctors were wrong and yet Met never had her examined. We contacted a lawyer and he said we could not sue because of ERISA. He also said he doesn’t do short term disability so she is effectively screwed. Met Life can do as they wish because there is no repercussion if they don’t. Even if you sue they can’t be punished because of ERISA. All the judge can do is make them pay you what they would have had to anyway. It’s a travesty this law even exist. Your Congress at it’s best. Let some lobbyist for the insurance company pay for a few dinners and bingo, insurance has a law that in effect protects them from ever having to do the right thing and completely denies average Joe the ability to be compensated for the BS they put you through. Stay away from Met Life!

    Jim R.Oct 25, 2015  #5

  • D. Perry,

    What is the status of your husband’s disability claim? Is he still within his timeframe to file an appeal? Please feel free to contact our office to discuss your husband’s claim.

    Stephen JessupJul 18, 2015  #4

  • My husband who suffered a massive heart attack an now needs a heart transplant… was in the hospital for close a 1 year. Trying to manage our financial life while my husband was fighting for his life was so stressful. Met life & my husbands place of employment for 34 years had absolutely NO compassion! Its pretty sad that this is what it has come to. We tried to be prepared for the worse, you pay your ins premiums hoping you will never need your insurance, suddenly the day comes an you need it an they throw you under the bus. Our advise to everyone, put your money in a bank account for this situation… Insurance Company’s are legal thieves.

    P.S. Don you said it straight… Met Life stop ripping people off!

    D. PerryJul 17, 2015  #3

  • MetLife is large scam company, you pay ur bi-weekly dues and expect them to cover you when you’re sick or injured, and they refused to uphold their end, by refusing coverage or just flat-out refusing to assist. They are getting away with fraud by using non medical personnel to determine the legitimacy of client’s claims. Dig this, when claim does go through, they want to pay them back. How crazy is that!?

    By the very definition: Insurance – an agreement by which a company or the state undertakes to provide a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a specified premium.

    Step up MetLife, stop ripping people off!

    Don GouchJul 20, 2014  #2

  • Metlife is refusing to pay me for my other 7 days disability. They are scam artists putting in wrong dates, when you have the paper work to prove they are wrong. I have been back to work for over a month and still haven’t received my money!

    KimFeb 16, 2014  #1