Metlife Overturns Denial on Appeal by Dell & Schaefer

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 & Schaefer

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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FAQ

Do you help MetLife claimants nationwide?

We represent MetLife clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a MetLife disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from MetLife. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by MetLife.

How do you help MetLife claimants?

Our lawyers help individuals that have either purchased a MetLife long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with MetLife:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

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 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.

What are your fees?

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.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. 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.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer 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.

Dell & Schaefer Client Reviews   *****

Greg S. (Arizona)

After practicing dentistry for 34 years, I was forced to stop working due to a long history of cervical degenerative disc disease and associated complications that impair my ability to practice my profession. When I learned that this was a permanent condition and I would likely never be able to practice again, I contacted Dell & Schaefer to assist me with filing my private disability insurance claim. I wanted the expertise and guidance of an experienced disability attorney from the beginning so that I would not be faced later on with having to undo problems I might unknowingly create on my own.

I was most fortunate to be represented by Mr. Steven Dell, who patiently answered each one of my questions and carefully steered me through every step of the disability claim process. He thoroughly got to know me, the history of my condition, and as my legal professional intermediary with the insurance company, guided me in compiling everything we needed for him to submit the claim for me. When Mr. Dell called to give me the good news that my claim had been successfully awarded and that he would continue to “be there” for me going forward, it was clearly confirmed to me that the key to this successful outcome was my decision, early on, to contact Dell & Schaefer.

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