Teacher's Disability Benefits Reinstated by MetLife
Our client, a former elementary school teacher in Broward County Florida was forced to stop working to undergo lower back surgery with a fusion. Prior to the scheduled surgery he pre-emptively filed a short-term disability claim with MetLife, which was approved prior to his surgery. Despite the surgery being a “success”, it did not alleviate his pain completely and he continued to experience radiating pain, tingling and numbness into his lower extremities. His claim transitioned from short term disability and into long term disability as updated CT scans indicated that the fusion was healed and not yet fully solidified. MetLife approved his claim for long term disability policies but quickly thereafter began aggressively reviewing his claim, which culminated in a denial of benefits less than 1 year after his surgery. Our client contacted our office shortly after receiving the denial letter.
Does MetLife Have to Examine You Before Denying Your Disability Benefits?
No. MetLife, or any insurance company, is not obligated to have you physically examined before denying a disability benefit. In our client’s case, MetLife’s denial was predicated on a paper file review performed by a hired consultant who reviewed the available medical records and determined there was no evidence to support that our client suffered from a medical condition or combination of conditions of such severity to warrant placement of any restrictions or limitations as to his activities. Before denying the claim, MetLife didn’t even wait for a response from our client’s doctor as to its doctor’s report before terminating the benefit. With a one-sided paid for opinion, MetLife determined our client was no longer eligible for disability benefits.
Do I Have To File An Appeal With MetLife After They Denied My Benefits?
If your coverage is through an employer provided policy, yes- you will need to file an administrative appeal with MetLife. Our client was unsure of the steps that had to be taken but after his experience dealing with MetLife he knew he did not want to fight them on his own. In our initial call I explained to him that MetLife only allowed for one level of appeal prior to the filing of a lawsuit. Unlike most people with MetLife policies provided by their employers, our client’s policy was not governed by the federal law, ERISA, as he worked for a government entity. For reasons discussed throughout our website, not being subject to ERISA has many benefits should a lawsuit be filed, but it didn’t make the appeal process any less important.
Building The Case For Disability Benefits
In reviewing our client’s claim, it was apparent that we had multiple obstacles to overcome. First and foremost, we had to establish that our client was disabled from performing the material duties of his regular occupation as a elementary schoolteacher. Second, since our client was not likely to go back to work, we also had to prepare the claim for the 24 month change in definition of disability from the inability to perform his own occupation to the inability to perform any occupation as defined in the policy. Finally, his policy with MetLife contained a 24-month limitation for neuromusculoskeletal/soft tissue disorders, which would seek to limit his maximum monthly benefits to 24 months total, unless he met one of the enumerated exceptions to the limitation, in his case- evidence of radiculopathy.
The first step in establishing the presence of restrictions and limitations that would support his inability to work as an elementary school teacher necessitated a Functional Capacity Examination (FCE). The FCE would form the basis of undermining the opinion of MetLife’s file review doctor and provided additional objective evidence for our client’s doctors to utilize when commenting on our client’s medical condition. The FCE also served to help establish our goal of preparing our client’s claim for the 24-month transition in definition of disability from “own” to “any” occupation.
The FCE results indicated that our client would not be able to meet the physical demands of his prior work, but also that he did not have a full gamut of sedentary physical ability to perform any occupation on a full-time basis. After receiving the report, we sent requests for opinions and statements from seven of our client’s doctors. Whereas MetLife would rely on one doctor who never met our client or spoke to one of his doctors, we were prepared with an overwhelming amount of medical support. To address the concerns as to the 24-month limitation contained in the policy as it related to our client’s medical condition, we had him undergo EMG and nerve conduction studies with his doctors to establish the presence of radiculopathy and in turn get around the limitation.
Within 45 days of submitting the appeal, MetLife advised our office that it was overturning its denial and reinstating our client’s claim for benefits. Although our client’s claim has not made it to the 24 month change in definition of disability, we are well prepared to confidently argue his ongoing entitlement to benefits when MetLife begins that review.
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Submit a Strong MetLife Appeal Package
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Policy Holder Rating
They will do anything to not approve your claim
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They FULL OF ****
MetLife for disability? Avoid the surgery unless it's life-threatening
Only care about $$$$$
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They demanded an overpayment, stopped my claim, and lied about it
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Your decision making process is absurd!
My husband has 2-5 yrs to live, yet MetLife has been giving him the run around
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Inappropriate conduct!! Rude, discriminatory, etc
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5 Ways We Help Get Your Benefits Paid
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
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.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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 insurance 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.
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.
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.
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.