MetLife denies physician’s long-term disability claim as a result of late application filing

When Dr. Beatriz Martinez received a letter from MetLife denying her claim for long-term disability insurance, her only remaining option was to file a lawsuit. Unfortunately for her, the court upheld Met Life’s denial for one primary reason, she filed her claim for disability benefits four months too late. No arguments put forth by her attorneys could change that fact, and in the end, her appeal was denied, and she lost her lawsuit.

This issue arises far too frequently. Let’s look at Dr. Martinez’ story. There are important lessons for all of us.

Dr. Martinez began employment with the Family Health Care Centers (FHC) of Southwest Florida as a physician. As an employee benefit, FHC offered long-term disability insurance through MetLife.

Just one month after she began work, she suffered a grand mal seizure. Diagnosis? A brain tumor. She underwent surgery. She returned to work two months later, but her health continued to deteriorate. As it became apparent that she could not fill her role as a physician, FHC reassigned her to work as a bilingual health educator. She held this position for a year before she finally reached the point where she could no longer work.

Meanwhile changes had been taking place with FHC. One month before Martinez left her position at FHC, the company cancelled its long-term disability plan with MetLife. When Martinez filed a disability claim with MetLife a year later, MetLife turned down her claim.

Here’s why MetLife denied Martinez disability claim

First, they asserted that her coverage didn’t become effective until after her brain seizure occurred, thus she had a pre-existing condition that precluded being covered.

Second, they argued she did not have disability coverage because her last day of work was after FHC cancelled their plan with MetLife.

Third, they deemed her last day of work marked the beginning of her disability.

Here’s why Martinez believed she had a claim

She believed that her coverage began at the time of her initial employment.

She felt that her disability began when she had to downgrade from physician to health educator, not on the day she left employment.

Why did MetLife win?

MetLife won their case because Dr. Martinez failed to do one thing. She filed her claim too late. If her disability began on the day she was demoted, as she claimed it did, then she had one year according to the disability policy language to file her claim. She missed that deadline by four months. The U.S. Court of Appeals upheld the statute of limitations.

What lesson should you learn from this disability claim?

At the first sign of a potential disability, take action. If disability is an afterthought, you may find yourself in Dr. Martinez’ position – truly disabled and uncovered. It is far better to file a claim, then withdraw it because your situation improved. Time is of the essence when it comes to long-term disability claims.

Disability insurance policies contain complex and confusing contractual language. Enlist the assistance of a disability insurance attorney early. Disability insurance companies will seize upon any opportunity to deny a claim for benefits.  They are quite content to have people miss an important filing deadline. A disability insurance attorney can guide you through the challenging process of obtaining long-term disability insurance benefits.

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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.

Reviews   *****

John S.

Integrity and honesty is an important attribute to me. My Dell & Schaefer (D&S) attorneys meet and share these attributes. D&S have an entire staff dedicated to serving their clients. They’re all very approachable and friendly while keeping the client’s best interests at the forefront. You can contact or call them at the drop of a hat and they’ll assist you. You’re not treated like a number; you’re a respected individual and friend. They care. That’s how they make me feel. They often ask how I’m doing; how I’m feeling (I’m in a lot of pain). Most of all, under their protective umbrella, you don’t have to deal with the insurance company. D&S does all that. They keep things straight. It’s comforting. I would not hesitate to recommend them first and foremost for any disability legal needs.

I’m a retired Army Soldier. I’ve been disabled for about four and a half years. I was working for a company (post-military retirement) when I became disabled after an unsuccessful service connected C-spinal surgery that caused me serious complications. My disability is permanent. I had disability insurance with the company that I worked for as an added benefit. After I went down, and once I met the 6 month period for long term disability, the Hartford insurance company began paying monthly disability payments; however, they were always requesting additional information. It was always repetitive information, non-stop, i.e., asking for the same information I had provided only a few months prior.

They wanted repetitive doctors’ statements. I saw many doctors in my state in an attempt to fix or reverse what was damaged during my surgery in an attempt to return to work. My doctors all said the same thing. My medical condition was permanent. They all said I would not improve or get any better through more surgery or physical therapy. In fact, it might have gotten worse if I tried more surgery. There was nothing the neurosurgeons could do for me other than pain management, and continued PT for pain management to improve my quality of life. My disability insurance company continued to hound me for additional information despite what the doctors had already provided to them. It was ridiculous and it was obvious that the insurance company was trying to find anything to negate the policy.

About 18 months ago the Hartford insurance company requested an “in-home” interview with me. Despite the fact that my medical documentation was excellent and well documented regarding my disability, I had grown tired of dealing with this company on my own. It had become stressful to the point that my health was suffering even more. I had no idea how to handle this powerful company at the pending interview and I felt I needed legal representation to get them off my back protect my rights during the interview. That’s when I decided to enlist the help of Gregory Dell. I found him on the internet, watched several of his You-tube videos, and I was convinced that he was the legal representation I needed to guide me and protect me from this insurance company and my right to disability benefits.

From the moment I contacted Gregory Dell and his attorney associate Alex Palamara, the lead attorney who handles my case, I was treated with respect and dignity. With little notice, both of these attorney’s guided me through a successful interview with the insurance company. They were present (via telecom) during the entire interview, which took about two hours. They had told me to be myself and to be totally honest with the investigator during the interview. That I was, but when I was offering too much information to the investigator, they would tell me when to stop. They’re experts in disability legal matters. I’m not and I listened carefully to their advice and direction. I’m glad I did.

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