Court Finds MetLife Has No Right To Request An IME After Unnecessary Delay
Recently, a claimant was forced to hire a California Disability Lawyer and file a lawsuit against MetLife after being denied continued Long Term Disability Benefits. After agreeing with the claimant that she was disabled through the “own occupation” period, the Court awarded the claimant benefits for that limited time period. However, the court then asked MetLife to take a closer look at the “any occupation” period. For an unexplained reason, MetLife dragged its feet on making a determination.
The question in Kroll v. Kaiser Foundation Health Plan Long Term Disability Plan et. al. and the insurer’s Motion to Compel an Independent Medical Exam (IME) concerned whether or not the insurer waited too late to request a IME for the claimant after the Court had remanded the original complaint concerning an abuse of discretion when the insurer incorrectly awarded Kroll disability benefits during the “own occupation” period.
The Court, in its original ruling, remanded Kroll’s claim back to MetLife so the decision could be to re-reviewed during the “any occupation” period. The remand occurred on May 13, 2011; and, MetLife requested that Kroll appear for an IME in October 2011. According to 29 C.F.R.§ 2560-1(f)(3), the insurer was to either settle Kroll’s claim within 45 days or inform her that they needed more time and information to make a decision. The insurer did neither. Kroll however did provide MetLife with some 1,000 pages of medical records to supplement her claim, which should have triggered some response from the insurer. Unfortunately, for the insurer, it waited too long to request an IME, and thus, the District Court Judge ruled that the insurer did indeed fail to make its request in a timely fashion, and thus, Kroll was not required to provide it with an IME.
45-Day Rule Wins Case for Claimant
Consequently, in its order denying the Motion to Compel, the Court pointed out that the purpose of the 45-day rule per the Employee Retirement Insurance Security Act of 1974 (ERISA) is to see that claimants are able “to resolve disputes over benefits inexpensively and expeditiously.”
And, since MetLife was unable to offer any reasonable explanation as to why it delayed in either notifying Kroll that it wanted an IME, providing her with forms to file her claim under the “any occupation” standard, the Court felt it had no alternative but to deny MetLife’s Motion to Compel, stating that it is too late for the insurer to request an IME and that for all intents and purposes “the Plaintiff’s claim for long term disability benefits under the ‘any occupation’ standard is deemed exhausted.”
For similar cases and more information on MetLife, please click here.
Resources to Help You Win Disability Benefits
Submit a Strong MetLife Appeal Package
We work with you, your doctors, and other experts to submit a very strong Metlife appeal.
Sue MetLife
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Metlife.
Get Your MetLife Disability Application Approved
Prevent a MetLife Disability Benefit Denial
Negotiate a MetLife Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
They demanded an overpayment, stopped my claim, and lied about it
Reply
Your decision making process is absurd!
My husband has 2-5 yrs to live, yet MetLife has been giving him the run around
Reply
Inappropriate conduct!! Rude, discriminatory, etc
Reply
Haven't been paid since MetLife denied my appeal months ago
Reply
Metlife closed my STD claim amid several injuries
Reply
Metlife's COLA recalculation cut my payments with no explanation why
Reply
MetLife stopping my benefit plan. I'm still disabled
Reply
Q: MetLife: Mental Health and Physical Disabilities
Q: Can my employer switch my job because I go on LTD?
Q: Can MetLife deduct the ssdi benefits I receive for my dependent kids from what they pay me?
Q: Is MetLife entitled to overpayment if they realized 15 years later?
Q: Do I have to sign and return MetLife's authorization to disclose my info in order to continue my claim?
Q: How long does MetLife have to render a decision on my application for benefits?
Q: I found out about my STD policy 120 days late. Can I do anything?
Q: Does my former employer owe me STD that he refused to pay earlier?
How Does Having A Disability Lawyer Help Me Fight For Metlife Disability Benefits?
What Should I Expect if Metlife Wants to Send Someone to Interview me?
MetLife Disability Buyout and Lump Sum Settlements are Back
Metlife - Latest trends seen in handling ERISA and private disability insurance claims
Disability Denial Reason #1 – Paper Review & IME
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
Applying for Standard Disability Benefits? Top 5 Claim Denial Reasons
Guardian Disability Benefit Claim Handling Tips
Teacher's Disability Benefits Reinstated by MetLife
MetLife Denies Disability Benefits and Tells TFORCE Truck Driver Its Safe For Him to Drive
Contracts Manager With Toxic Encephalopathy Wins MetLife Long Term Disability Denial Appeal
MetLife Approves Long Term Disability Claim For Executive Assistant with Neck Pain
MetLife Approves Disability Benefits to Dentist With De Quervain's
Dell Disability Lawyers Successfully Appeals Metlife Denial of Benefits to Veteran
Metlife Overturns Denial on Appeal by Dell Disability Lawyers
Senior Global Tax Director for billion dollar worldwide industrial company is again receiving disability benefits from MetLife after Appeal by Attorney Alexander Palamara
Reviews from Our Clients






