Tax Director Wins Metlife LTD Insurance Appeal for Depression

To say my client had an intellectually demanding job is an understatement. The corporation he worked for operates in 35 countries and employs over 12,000 people worldwide. As a Senior Global Tax Director, amongst many duties, he was charged with developing and coordinating the Tax Policy of the company to ensure timely international tax compliance filings and execution of tax strategies. It was certainly an occupation that required intelligence, knowledge and constant research into the ever changing tax laws of various countries. While challenging, his work was rewarding both mentally and financially.

Unfortunately in September of 2016, he was forced to stop working due to serious mental health issues. His conditions severely impacted his ability to focus and concentrate which were certainly required with his intellectually demanding occupation. There was just no way he could continue working while suffering through his symptoms as one error could result in serious issues for the company. Luckily he had coverage under a Group Long Term Disability Insurance Policy with MetLife. After filing for his claim, MetLife agreed he was disabled and benefits began on March 1, 2017, after the client satisfied the 6 month elimination period. Unfortunately this approval did not last long. As of March 28, 2017, MetLife determined he was not eligible for continued benefit. It seemed as if MetLife believed that he was magically better.

Relying upon a review by a “Clinical Consultant”, MetLife came to the conclusion that there was no evidence of ongoing impairment or treatment escalation to support impairment after March 28, 2017. As such, it denied further benefits. Confused as to how he could possibly be denied as he was still suffering from numerous issues, the Tax Director called our law firm for Assistance.

Appeal by Attorney Palamara

After reviewing the short denial letter and speaking with the former Tax Director, it was obvious that MetLife’s decision was wrong and the review it had relied upon was shoddy or just based on incomplete information. An appeal strategy was put together and ultimately a timely appeal was filed. The appeal focused on the medical records of our client’s treatment. We also worked with one of his psychiatric providers who agreed to provide supportive statements which showed that our client was markedly limited in many intellectual areas. Also, the appeal challenged each of MetLife’s arguments in its denial letter. Remember, MetLife had tried to state that there was no evidence of ongoing impairment or treatment escalation. As such, we showed indisputable evidence of what they alleged was missing. Not only did we provide all the relevant medical records, we also summarized his ongoing treatment history which proved that MetLife’s contentions were just wrong.

Essentially, we proved that MetLife ignored evidence it was provided and we proved that our client satisfied the definition of disability.

Claim is re-approved

We can fortunately report that after 90 days of reviewing the appeal, MetLife made the determination that “the previous claims decision will be reversed and (our) client’s benefits will be reinstated.” Our client was paid all the benefits owed to him from March 29, 2017 through the date he was reapproved. He is set to continue on claim into the future, though his benefits are likely limited to a total of 24 months as his policy has a mental illness limitation which limits claims for mental illness to a total of 24 months. However, our client knows that Attorney Palamara will do whatever it takes to ensure that he receives all the benefits he is possibly owed under the policy.

If you have been denied benefits by MetLife or have any questions regarding a long term disability insurance policy, please do not hesitate to contact us. We always offer a free consultation and you will always speak with an attorney.