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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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