Chiropractor Obtains Lump-Sum Disability Insurance Settlement Despite Wrong Date of Disability

Caution, the timing of a disability claim can mean the difference between having your claim approved or denied. Far too many times I have seen disability insurance claims denied because the claimant either failed to promptly file their disability claim, mistakenly adopted the date which the insurance company claimed their disability began or state an inaccurate date of disability on the initial application for benefits. The claimant’s date of disability is crucial in determining: 1) what the claimant’s “Own” or “Regular” Occupation is; 2) how long the claim could be paid; and 3) if the claim will be paid.

When The Claimant Purchased His Disability Policy He Was Gainfully Employed As A Chiropractor

Our client, Dr. Z, had attended college and trained to become a chiropractor. When he purchased his individual disability insurance policy with Metropolitan Life Insurance Company (“MetLife”), he had recently begun working as a chiropractor and his duties consisted of performing manual chiropractic adjustments on patients. Dr. Z soon successfully grew his practice and was operating 4 different chiropractic offices.

Generally, the definition of “own/regular occupation” in an individual long-term disability policy (Non-ERISA) means the usual occupation (or occupations, if more than one) in which you are Gainfully Employed at the time that you become disabled. This means that the disability insurance coverage should follow you from occupation to occupation, and will not be limited to only covering the occupation that the insured is performing at the time that the disability insurance policy is purchased.

Metlife Denies Disability Claim Of Chiropractor Due To Change In Occupation Prior To Date Of Disability

Dr. Z began experiencing bilateral pain in his knees and feet, and would experience difficulty walking. It was discovered that Dr. Z suffered from complex regional pain syndrome. He continued working in his practice, but was eventually forced to close most of his offices due to the pain and discomfort he experienced especially when treating patients. At around this time, Dr. Z also began teaching part-time for a local university and working as a Residual Functional Capacity/Vocational Specialist for the Social Security Administration. Dr. Z also notified MetLife that he had become disabled from performing his duties as a chiropractor, however, on his application for disability benefits he provided MetLife with a date of disability which followed the date that he began working for the university and the social security administration.

MetLife had Dr. Z’s claim reviewed by a physician consultant who determined that Dr. Z would indeed have restrictions and limitations from running, jump, climbing stairs, standing, stooping and kneeling, and perhaps even performing the duties of a chiropractor. However, MetLife determined that although Dr. Z had these restrictions and limitations, he was not disabled under the terms of the policy since he was continuing to work and could work in his teaching and vocational consultant positions. Dr. Z was shocked and could not believe that his claim was denied, as it was his belief that he should be paid since he could no longer perform his regular occupation as a chiropractor.

Dell Disability Lawyers argues that Dr. Z’s regular occupation was his occupation as a chiropractor, the usual occupation (or occupations, if more than one) in which he was Gainfully Employed at the time that he become disabled.

Following his denial of disability benefits, Dr. Z consulted and retained Cesar Gavidia and Dell Disability Lawyers to represent him in his disability claim with MetLife. Following several meetings, a review of the claim documents, medical records, and financial records for Dr. Z’s chiropractic practice, it was determined that Dr. Z had chosen an incorrect date of disability. Dr. Z had assumed that his date of disability was the date he completely discontinued seeing patients, when, in fact, his date of disability should have been stated as being even earlier – when he began reducing his patient volume and duties, and before he began working as a vocational consultant and teacher. MetLife was notified of the incorrect date of disability, but they were not willing to change their determination.

MetLife was provided with the opportunity to correct Dr. Z’s date of disability and pay his disability claim; however, it continued to deny that he was eligible for disability benefits. Following several weeks of negotiations, which included threat of suit by Dr. Z, attorney Gavidia negotiated a confidential settlement between Dr. Z and MetLife.

Dr. Z’s case is a perfect example of why the timing of a disability claim and the actual date the insured claims disability are so important. In Dr. Z’s case, claiming total disability 12 months earlier meant the difference of thousands of dollars, and the difference between his claim being approved or denied. As in Dr. Z’s case, most disability policies state that the claimant is disabled from the occupation or occupations that they are performing at the time that disability begins. It is important to carefully analyze how and when the claimant’s disability began affecting their ability to work and generate income.

Contact us for a free consultation to discuss how we can assist you with your disability insurance claim. For more Metlife disability cases and user reviews please click here.


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Only care about $$$$$

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PLAY THEIR GAME FIGHT FIRE WITH FIRE.....after getting a copy of the insurance policy from my HR. I nipped a lot of the headaches quickly by calling their bluff word for w... read more >
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Allen,
Sorry to hear what you have been through. I am glad you fought back.

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They demanded an overpayment, stopped my claim, and lied about it

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Metlife over paid me. Stopped my Ltd claim. The overpayment were not done right. They lied and said they deposited money in my account.
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Diana, I am sorry to hear of this denial and the demand for an overpayment. Please contact us so that we can review your claim and see if we can get you back to receivi... read more >

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Your decision making process is absurd!

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My husband has 2-5 yrs to live, yet MetLife has been giving him the run around

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Sent on March 19th 2021 by Attorney Gregory Dell

Tina, I am so sorry to hear that MetLife and the employer have been giving you the run around. From everything that you described, your husband’s claim should be a qu... read more >

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Inappropriate conduct!! Rude, discriminatory, etc

Reviewed by Deanne on January 31st 2021   Verified Policyholder
Have you ever dealt with a case where the person is receiving LTD benefits but there have been issues with the case manager? For instance, the person was badgered about an... read more >
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Sent on January 31st 2021 by Attorney Jay Symonds

Deanne: This certainly does not sound like appropriate conduct on the part of the claims personnel. Are you still collecting an LTD benefit? I suggest you contact our o... read more >

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Haven't been paid since MetLife denied my appeal months ago

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Rosanne, I am sorry to hear of your denial. Please contact at once for a free consultation. We should be able to assist you with the next available steps.

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Metlife closed my STD claim amid several injuries

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Donnette: This is a very unfortunate set of circumstances. Have you received a written denial letter? I suggest you contact our office and speak with one of the attorne... read more >

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Metlife's COLA recalculation cut my payments with no explanation why

Reviewed by Tori on September 10th 2020   Verified Policyholder
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Sent on September 10th 2020 by Attorney Gregory Dell

Tori, we are not involved in any class action at this time with MetLife, however, we will gladly review your policy to see if their updated calculations for your COLA a... read more >

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