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Question

Can I sue Metlife for non payment of approved claim?

Asked on December 28th 2023 by Mistaken
My claim was approved. They did not payout and said there were two claims and one wiped out the other. Not true according to the site were you can look up your claim, plus I called several times. Bills are piling up and my car insurance has been canceled, which is my only means of getting around. The girl made no sense on the phone and said now because it's been so long that a manager has to approve payment. I was expecting payment on the 22nd of December, three days before Christmas and nothing. Then they gave me this mumbo jumbo and mistake was made. Now I'm waiting again. I almost feel this was done intentionally, girl very rude who is handling case.

Answer

Answered on December 28th 2023 by Attorney Stephen Jessup

Unfortunately, the answer is "not liklely." I would assume your MetLife policy is an employer provided policy and as such would be governed by the federal law, ERISA, which would require an appeal prior to the filing of a lawsuit. From the information provided the claim was approved but some internal error with MetLife that voided out payment in their system. It should be rectified and benefits paid, but I do not think they would be liable for legal repercussions for the error if they rectify and pay. You could file a complaint with your state insurance commissioner to at least bring it to light resulting in MetLife being in a position to have to respond to the complaint. Please note that your state insurance commissioner's office would not have the power to force MetLife to pay any type of fine to you. Please feel free to contact our office to discuss the situation further, especially if MetLife does not pay the claim- then you would have rights to appeal a denial and then potentially sue.

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