MetLife Approves Disability Benefits to Dentist With De Quervain’s

Prior to contacting our office, our client filed a claim for long term disability benefits under his individual disability insurance policy with MetLife on account of de Quervain’s Tenosynovitis, a condition affecting the tendons of the thumb and wrist that resulted in severe pain in his dominant hand, especially with grasping. Given the nature of his occupation as a Dentist, and the fact his condition was affecting his dominant hand it was clear that he would pose a risk to patients should he continue to practice dentistry. Accordingly, MetLife initially approved our client’s claim. While on disability he underwent surgery to alleviate the symptoms but the results of surgery were less than ideal.

Continued Claim Review

Despite undergoing the surgery our client continued to experience throbbing pain in his wrist and hand, which his surgeon could not determine the basis of in light of the surgery performed. With uncertainty as to the cause of pain, as well as what MetLife deemed to be the subject nature of same, in light of a “successful” surgery, MetLife began to question whether our client continued to meet the requirements of disability under his policy. In an effort to gain a better understanding of his continued symptoms our client sought a second opinion, which ultimately determined that our client was experiencing nerve damage, which was continuing to affect his ability to use his hand.

MetLife’s doctor’s review of the medical findings was not so clear and MetLife notified our client that it was denying his claim for continued benefits. Our client reacted immediately and availed himself of the voluntary appeal process MetLife offered under his individual disability policy. Shortly after filing the appeal, MetLife informed our client that it had arranged for him to undergo an Independent Medical Examination (IME) to better assess the extent of his medical conditions and ultimately determine whether MetLife would reinstate his claim for disability benefits.

Our client believed that the IME was positive/favorable to his claim and that the examining doctor agreed with his treating physician as to the nature of his continued complaints and there impact on his ability to perform the duties of a dentist. However, MetLife continued to drag its feet in finalizing its review and informed our client that it was seeking additional clarification from the IME doctor before it could render a decision. As nearly six months had passed since MetLife stopped paying benefits, and with no end in sight as to MetLife’s delay tactics, our client contacted our office to seek legal representation and spoke with Attorney Stephen Jessup.

The Claim Decision

Having represented numerous dentists over the past decade, Attorney Jessup was familiar with our client’s medical condition and how a private disability insurance carrier like MetLife would be evaluating the information to finalize a claim decision. Attorney Jessup’s first course of action was contacting MetLife to advise them that our client was now represented by counsel and to demand clarification as to the status of MetLife’s review of our client’s claim. A request was made that MetLife make payments to our client under Reservation of Rights while the review of his appeal took place, but MetLife was adamant that no benefits would be paid during the course of the appeal review.

Not willing to approve benefits without a fight and due to differing opinions of its doctors and our client’s, MetLife arranged for our client to undergo another IME with an occupational therapist specializing in examinations of the hand. Following this second examination, Attorney Jessup was able to secure a copy of the IME report from MetLife. Review of the IME report did in fact indicate that the examiner agreed with the findings our client’s doctor (and that of the initial IME doctor)  of nerve pain that was resulting in not only continued pain of the right hand and wrist with use, but also numbness and loss of sensation throughout our client’s hand. Despite these findings MetLife did not approve our client’s claim immediately and advised Attorney Jessup that its medical reviewers were seeking clarification from the two IME examiners and our client’s doctor.

Attorney Jessup pressed our client’s position with MetLife and threatened to bring suit under the policy to secure our client’s benefits. In light of all the information in our client’s file, MetLife was left with little choice but to reinstate our client’s individual disability benefits and pay nearly a year in past due benefits. However, Attorney Jessup knows that the approval of the claim will not be the end of MetLife’s continued review and inquiries into the future of our client’s claim.

Is your disability carrier challenging your claim?

Our office has represented numerous dentists and other medical professionals in disputes with their disability carriers as they relate to medical conditions that limit the ability to perform occupational duties, but otherwise have very little negative impact on the client’s day to day activities. Insurance companies will challenge these claims when there is limited diagnostic evidence to support the claim, or as was the case with our client, standard diagnostic testing (EMG/Nerve Conduction Studies) did not clearly define a diagnosis. Rather, the diagnosis was made based on clinical examination.

It is imperative that an insured’s medical records accurately reflect the symptoms, restrictions and limitations that the insured is experiencing, especially in the absence of firm objective medical evidence.

If you have questions regarding your disability insurance policy/claim, please feel free to contact our office to speak with one of our disability insurance attorneys.


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FAQ

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   *****

Todd P.

I would like to thank you and your firm for the fantastic job that you did on my disability denial case. From the moment that I first contacted you up to the moment that I received my notice of you winning my appeal your service was beyond exceptional. My case was not an easy one, because I had waited to file an appeal which caused a very limited time frame for your firm to act. Even though your back was up against the wall you never made me feel rushed to deliver paperwork and you always kept me in the loop of how far we were along in the process. Whenever I sent an email I received an instant response. Whenever I called, someone was always available to answer my questions.

After winning my case I sent in my direct deposit info and two days later my first disability check was in my checking account. Everyone that had a hand in my case was a true professional. I cannot stress enough how service like this in today’s world is just not heard of anymore.

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