Metlife Overturns Denial on Appeal by Dell Disability Lawyers
Mr. W was working as a Quality Assurance Engineer for a major technology company when he was forced to stop working at the age of 52. He had been suffering from severe heart disease and co-morbid complications. He also suffered a heart attack and had a progressively worsening diabetic foot ulcer which required him to use a knee scooter to ambulate.
After filing a claim for disability benefits under his employer sponsored disability plan, MetLife approved his claim and paid benefits effective October 2015 for his inability to perform his occupation due to his chronic foot ulcers.
Initial claim approval and subsequent denial
MetLife paid benefits to Mr. W for two years before sending him a letter in October 2017 notifying him that his benefits would be ending. The denial letter included statements from Mr. W that his condition had improved in that he was “not using a knee scooter 100% of the time.” The denial also relied on an Attending Physician statement (APS) from a treating physician indicating that Mr. W was released to return to work with restrictions.
Mr. W contacts our firm
Almost immediately after receiving the denial letter, Mr. W contacted our law firm and spoke with us. We reviewed the denial letter and it became clear that it was a claim that had been damaged by the improper completion of claim forms by the treating physician as well as the claimant.
The denial was most likely the result of misleading questions on confusing claim forms which claimants and their doctors are required to complete for the claimant to continue receiving disability benefits. As one of the most common reasons for a disability denial, we see frequent denials where the insurance carrier relied on statements from claim forms that do not accurately reflect the claimant’s condition. Statements describing an “improvement” or “normal” or “stable” conditions are often mischaracterized by the insurance company and used as a basis to deny a claim.
Such was the case with Mr. W when he received his denial letter from MetLife. The appeal had to undo the damage that had been done and which MetLife relied on to deny the claim. Our team focused on gathering evidence that proved that Mr. W’s condition had not improved. In the process of preparing the appeal it also became apparent that MetLife had placed too much weight on and focused almost primarily on Mr. W’s foot condition as the sole cause of his ongoing impairment. It also became clear that MetLife had misconstrued the attending physician’s statement which it declared supported a denial of benefits.
Appeal by Dell Disability Lawyers
To paint an accurate picture of Mr. W’s actual functional abilities, we elicited more detailed and more specific responses from the treating physician most familiar with Mr. W’s condition. The doctor’s responses supported that Mr. W was unable to perform even a sedentary occupation on a full-time basis. In total, the appeal consisted of 3,432 pages of arguments and medical exhibits supporting Mr. W’s claim.
MetLife took less than 45 days to review the appeal before overturning its adverse decision and issued a letter to our office that Mr. W’s claim would be reinstated.
This case is a perfect example of a claimant who deserved to be on claim but was a victim to the misleading and confusing questionnaires provided by insurance companies. Claimants and their treating doctors often struggle to complete these forms and mistakes are easy to make when you don’t have experience filling out the forms. Fortunately Mr. W contacted our office in time and we were able to get him back on claim.
Mr. W continues to be represented by our office and continues to receive disability benefits.
If you have a similar claim or you are struggling to complete the forms required by your insurance company please contact one of your attorneys to discuss your options. It is important to get an attorney involved before it’s too late.
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MetLife Reviews
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They FULL OF ****
MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >
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MetLife for disability? Avoid the surgery unless it's life-threatening
The worst company I ever dealt with, never received a call from my claim manager.
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Only care about $$$$$
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They demanded an overpayment, stopped my claim, and lied about it
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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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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Showing 8 of 76 Answered Questions
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A: Jim:If this payment is a form of a retirement or pension payment then it is likely correct for Metlife to of... Read More >
Q: Do I have an option after my appeal is denied?
A: Lauren:If your appeal is denied by MetLife then you have the option to file lawsuit in federal court. Read More >
Q: My daughter died in 2019
A: If your daughter was disabled prior to being terminated then she should have coverage. Read More >
Q: Can I sue Metlife for non payment of approved claim?
A: Unfortunately, the answer is "not liklely." I would assume your MetLife policy is an employer provided policy ... Read More >
Q: How far behind in payments does Metlife have to be to take legal action?
A: Make sure you put all of your requests in writing so there is a record should you end up in court. It’s best... Read More >
Q: Does Metlife pay Disability payments ahead? Example: December payment is for January.
A: Peg, most disability insurers pay monthly disability benefits in arrears, in other words, payments are made fo... Read More >
Q: Would any new disabling conditions be considered by Metlife when considering whether or not to continue my benefits?
A: The change in diagnosis will likely lead to denial so please explain the situation to your treating doctor. Me... Read More >
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A: If you have physical disabilities that prevent you from working then you have options to get around the mental... Read More >
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Metlife Overturns Denial on Appeal by Dell Disability Lawyers
Mr. W was working as a Quality Assurance Engineer for a major technology company when he was forced to stop working at the age of 52. He had been suffering from severe heart disease and co-morbid complications. He also suffered a heart attack and had a progressively worsening diabetic foot ulcer which required him to use a knee scooter to ambulate.After filing a claim for disability benefits under his empl... Read More >
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Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
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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.
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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. 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.
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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.