Attorneys for MetLife Disability Claims
Metlife Disability Insurance Claim Information From Lawyers- Why Its Important To Hire A Lawyer For A MetLife Disability Claim
- Metlife Disability Field Interview Request Are On The Rise
- MetLife Disability Insurance Company (Ep. 7, part 1/2)
- MetLife Disability Insurance Company (Ep. 7, part 2/2)
- MetLife Disability Denial Reversed By Court For Unreasonable Claim Handling (Ep. 14)
- Metlife Long Term Disability Lump Sum Buyouts
- Deposition of medical consultant hired by MetLife for a disability insurance claim (Ep. 18)
- MetLife Request for a Disability Insurance IME Exam Denied By California Judge
With more than $70 billion in annual revenues, MetLife is a financial monster that you should not fear. While Met is great at making money, they are overwhelmed with administering short term and long term disability claims. The MetLife disability insurance claim division administers both Group ERISA disability plans and private disability insurance policies.
Through the litigation of numerous lawsuits against MetLife and the daily representation of MetLife disability claimants our firm has the knowledge and skill necessary to enforce our client’s contractual rights.
Does MetLife Pay Disability Benefit Claims?
As one of the world’s largest corporations MetLife routinely commits the same actions resulting in unreasonable disability claim denials.
Our firm has recovered disability benefits for 99% of our MetLife clients. Our job as your disability attorney is to make MetLife pay you the disability insurance benefits that you are entitled to receive. Our disability attorneys represent MetLife claimants at any stage of a disability claim, which includes the application process, on-claim handling, ERISA appeals and lawsuits.
At any given time, our law firm usually has numerous lawsuits pending against MetLife. You don’t need to wait for a claim denial in order to get us involved.
Free MetLife Disability Claim Information, Cases, Videos and Comments
We are of the opinion that a disability claimant should be well educated about their disability insurance company and the manner in which their company handles disability claims.
This section of our site contains videos about MetLife, cases our firm has resolved against MetLife, and a summary of lawsuits and court decisions involving MetLife.
We want you to learn what other MetLife claimants have said about MetLife, so we have created a public forum where MetLife claimants can either post comments on our website about their experience with MetLife or ask our lawyers general questions.
We encourage you to review all of the information about MetLife and to contact us if we can assist you with your claim.
I have a claim with UNUM. They administer my GenAm policy owned by MetLife. I filed in August. I have yet to receive an approval or denial. I feel like they’re continuing to come up with new request after new request in the hopes that something will turn up that would favor a denial. What is your process for evaluating a representation relationship with a potential claimant?
Larry, since your claim is pending we need to review your disability policy in order to determine if we can assist you. Please call us to discuss your claim and we will provide a free consultation to discuss your claim.
I worked for 35 years and had Metlife thru my last employer. I became ill with Aids, Neuropathy in my feet, legs and hands, chronic fatigue, chronic pain, entiritis of the intestines, chronic nausea, shortness of breath, arthritis in my spine and right wrist, GERD, hepc, depression and panic attacks. My doctor took me out of work because the stress level was practially killing me. At that time I was put on disability for hiv with physical complications (2006). Sometime in 2008 Metlife without notifying me changed my disability status to a mental disordered. By doing this they were able to cut off my benefits in 24 months under the plan I had at work. Even with tons of documentation from several doctors and a decision from a judge for SSDI benefits approved Metlife is still cutting me off. Before getting sick I worked for 35 years, had a house, a nice car, and a 401k plan for retirement. I am 52 years old and have lost everything now living on 60% of my earnings. Metlife treated me like I was subhuman and not worthy and that just made me more sick.
I had a disabilty policy with AMERCO (U-Haul) payable to age 65. I have received $688 a month for 11 years.Two years ago MetLife began administering the policy. Because I have a dependent child that also gets Social Security, they now claim that they want to reduce their payment by the amount of my daughters Social Security which leaves no money for me. What gives?
Mike, you need to review the Deductible Sources of Income section of your policy to see if the disability policy allows MetLife to deduct for payments to a dependent child. I have seen Metlife disability insurance policies that allow the deduction for a dependent child.
It has been 8 years since I was denied, but I did not know what to do, nor did I have the strength to “fight it” as you stated in the video because I have Fibromyalgia which keeps me fatigued and in sever pain ALL the time. Is it right that I will never get my disability benefits all because I was too disabled to “fight it”, plus I was trusting in Metlife (through IBM) to take care of me. Now I understand how evil they are, but I would like to try to still make them pay because I knew not what to do until recently, and even if I had known, I did not have the strength to fight it. Is it possible to get an exception of the statute of limitation (I’m in NC) since I knew nothing about it? And since I was trusting an untrustworthy company? This is so wrong! And I really cannot believe Metlife is getting away with this. btw, I was approved by SS right away.
Thanks so much!
Bob, we are sorry to hear about your denial of long term disability insurance benefits by MetLife. Unfortunately, there is no exception to the statute of limitations that we are aware of. The statute of limitations varies in each state, and the time period could be as little as 3 years and in some state as much as 6 years.
My wife is one hundred percent disable and she is on Social Security Disability and receives Long Term Disability Income from MetLife Ins. Metlife cut her amount of long term disability by the amount she gets each month from Social Security. Is this legal? One more question, will she receive benefits from MetLife for the rest of her life from the Long Term Disability? Thanks, Bert.
My husband is on long term disability. His plan was managed by Prudential until Jan of this year. We got a letter saying that MetLife will now be handling his claim. Not even a month later he gets a call from Metlife saying they are going to review his claim to see if he can work at all, at any job. My husband can barely do anything, he is always so fatigued due to the anemia, we do dialysis 5 days a week for 4 hours and now we have to fear that they are going to take the little bit of money he gets a month away. If they terminated his LTD he is going to lose his medical insurance and life insurance. I am so scared. Prudential and Social Security Disability both told me they usually do reviews every two years but because he is ESRD and on dialysis they would probably only do it like every ten years. Does anyone know what the chances are of them denying his continued claim?
Bert, you need to review the language in your wife’s Metlife disability insurance policy in order to determine if Metlife has a right to deduct the social security disability benefits. Most disability policies obtained through an employer have a deduction for social security disability benefits. You can write Metlife and ask them to clarify in writing their right to a social security offset. There is no guarantee that your wife will receive long term disability benefits the rest of her life. The disability carriers evaluate each claim on a monthly basis and if they believe that your wife is no longer disabled, then they will deny disability benefits. Your wife’s approval of SSDI benefits makes it less likely that she would be denied, but approval of SSDI benefits is not a guarantee that disability benefits will continue. Lastly, your wife’s Metlife disability policy probably states that benefits end at age 65 or 67.
Vickie, based upon your husband’s current medical condition it would be highly unusual for Metlife to deny his disability benefits. The forms that MetLife is requesting are routine and you should not be concerned. If you husband has been on disability for less than two years, then he may have a change in the definition of disability which takes palce after 24 months. This is another reason that Metlife may be requesting paperwork. You should anticipate that Met Life will request disability claim forms at least once every 2-3 months.
My sister has metlife and is on SS Disability, she also has a 13 year old son that gets funds from SS. Metlife deducts his amount from her payment. She has asked for a copy of her policy from metlife so that she can read the language that allows them to deduct this amount, Metlife has NOT sent her the contract. Metlife figures they have overpaid her $48000.00 and wants her to now pay it back, they continue to call her asking for the money, she continues to ask for a copy of the policy. How can she get Metlife to send her a copy of HER policy?
Kat, the ERISA regulation require the disability claimant to request a copy of their long term disability insurance policy from their employer and not from the disability insurance company. The request must be sent in writing and you should send it certified mail with signature confirmation. The employer has 30 days to produce a copy of the policy or they will be subject to a penalty of $110 a day.
After paying long term disability benefits for twelve and a half years, AT&T has started to deduct a vested pension, which AT&T claims was rolled over, in the sum of $50,000, by reducing the monthly LTD payment by $334 until the pension “overpayment” is repaid. Is the action taken by AT&T a contract claim? Does the New Jersey statute of limitations prevent AT&T from doing this? Can AT&T do this on its own without having first obtained a Court judgment?
Almost two years ago, my husband was taken out of work and deemed disabled by Metlife under his longterm disability insurance that he purchased through his job. He was required to apply for Social Security Disabilty which he did. First he was denied, then recently approved for Social Security Disability. Under the order, Metlife was supposed to supplement the SS to match his current disability payment. Within days of receiving notification of approval, Metlife decided that my husband was not sending in the paperwork properly and discontinued his claim until further paperwork could be submitted. The representative was told that he was approved for SSD, and information was sent to Metlife as requested. Now he gets a call stating that their (Metlife) nurse has reviewed his records and concluded that he was no longer disabled by their definitions. We are dumbfounded! Nothing has changed since day one except his condition has worsened and he has been diagnosed with several other issues. Is there Any recourse? Are we just screwed?
Karen, you may have recourse against MetLife, but we must review the denial letter sent by Metlife. If your husband’s disability policy is governed by ERISA then you must be aware that there are strict appeal deadlines that must be followed. Contact us and we will provide you with a free consultation to discuss your husband’s options.
My husband signed up for 1000.00 a week for short term disability from Metlife and he only received 400.00. They said he could not get more money on disability then when he worked. He paid for the 1000.00 a week premium. We have requested information from Metlife and they refuse to send us the contract or the original paper work that my husband filled out showing this amount and will not explain why he only received the 400.00 a week. How do we get this information? They keep telling us to go to his employer which he was let go from while on disability after working there for 13 years – or go to the Niagara Partnership Company which was the company who set up all the insurance from his employer. We have done all of thee above and are still refused this information. Now he is on long term disability, was denied SSDI and we are affraid they will stop his long term claim. Any help would be greatly appreciated.
Vincent, AT&T’s ability to deduct for your pension will depend on the language contained in your Long term disability policy. Your question is very specific and it can only be answered after a detailed review of your disability policy. The action taken by AT&T is a right they are exercising pursuant to the terms of your disability contract.
Nancy, if the disability benefits were offered through the employer, then you must send a request in writing to the employer. According to ERISA regulations, the employer has 30 days to respond or they could be subject to a $110 per a day penalty.
My husband has fought a panic disorder for 12 years with short periods of disability. He was approved for LTD folowing the term of STD through METLife. He attempted to return to work never really accepting that he was permanently disabled but it exacerbated his condition dramatically and he was placed off work permanently by two treating MD’s. MetLife cancelled and has refused thus far to reinstate his LTD despite letters and MetLife forms from both doctors stating he was permanently and totally disabled. Of course their MD who never had a conversation with my husband feels he can work. Is there any way to fight this and win? And why is a mental disability only given 24 months and any other disability is for five years? Isn’t that discriminatory?
Laurie, if you husband’s policy is governed by ERISA, then he must submit an appeal within 180 days. I would recommend that you call us to discuss the claim denial and we will discuss his options. Most MetLife group disability policies limit mental nervous conditions to 24 months. These limited pay period are usually valid.
I am currently receiving monthly payments from Metlife, as well as SSDI. When I received the SSDI back pay, there was a deduction from my checking account to pay Metlife – It was almost the complete amount that I received.
Now, I was granted a settlement award from the car insurance company of the wreck that started all of my pain. And, Metlife now wants 100% of this award. They have recently sent statements listing amounts that I have been “overpaid”. The totals on these statements do not total to the amount they have listed as the total in the cover letter, as I have tried to understand. They are still paying me, but I fear that they could stop at any time. I need advice, and quick.
How is it that they can demand this money from the auto settlement? Do I have to pay them? How can I fight this?
Jay, some MetLife disability policies provide for an offset if your disability is caused by a third party. In your case a third party would be the person that caused your injury. You need to look at the offset provisions of you policy. MetLife should only be entitled to an offset for the compensation you received for lost wages only. Your auto accident attorney needs to let you know what portion recovered was lost wages versus pain and suffering or medical bills.
Please help. I have recieved LT disability through MetLife for 2 1/2 years due to severe osteoarthritis, knee surgeries and knee replacement. Just recently I was approved for SSDI. My SSDI has me disabled due to “mental” issues (I have chronic depression and anxiety – everything went wrong with me mentally and physically after I got West Nile Virus 3 1/2 years ago).
Anyway, can Metlife now change my disability status to a mental diagnosis and decline benefits according to their “mental” clause of 24 month maximum beneifit period? If so, can they go back and demand to be repaid for anything paid over the 24 months? I still have the orthopedic issues and other medical issues due to West Nile. I am involved in Metlife’s rehabilitation program and they were going to begin paying for additional education starting in August. There is a plan in place with MetLife for me to eventually return to work in about 2 1/2 years.
Is everything on the line now due to the SSDI’s ruling? Am I at risk for losing my Metlife benefits?
I am currently receiving LTD benefits from MetLife, and have just been approved for SSDI benefits, so my payments form MetLife are now being offset by the amount I receive from Social Security. Since I also qualify for family benefits, this means my Met Life benefit has been substantially reduced. The problem is that My MetLife benefits were not taxable, but my SSDI benefits ARE. Since my wife is still working and earning it looks like my SSDI benefits could be taxed at up to 85%! I assumed that MetLife would have to reduce the offset by any amount of tax I had to pay but MetLife say they are NOT responsible for this difference. Is this legal? If so, it seems to me that I would be better off not receiving the SSDI.
Marcy, if the primary disabling condition is physical and your mental illness is secondary then the 2 year limitation should not be a concern. If you continue to be disabled by orthopedic issues then the findings of social security will not have any retroactive implications. If you are accepted to the Rehab program I have never heard of a situation where MetLife revoked approval.
Chuck, in the scenario you described it is true that you may be better off without the SSDI. We are currently researching pursuing a lawsuit against MetLife for people that are in your exact position.
What is the “rule of thumb” cost for an insurance company to defend against an ERISA lawsuit?
Steve, there is no rule of thumb cost for an insurance company to defend a disability denial case. Insurance defense firms usually work by the hour and charge anywhere from 175 hour to 450 hour. I have seen defense attorney fee bills from as low as 15000 to over one million dollars for defending an ERISA disability denial. The facts and issues are different in every case so there is no rule of thumb on defense cost.
My husband purchase MetLife Short Term disability through his employer, Home Depot. He injured his shoulder and had to have extensive surgery to repair the injury. MetLife was sending us a weekly check until he turned 62 and applied for Social Security. Not SSID – just regular SS. MetLife now says we owe them money because they deduct his SS payments from his MetLife payments. I could understand if it was SS disability, but not regular SS. We have asked Home Depot and MetLife for a copy of our policy and have not received one yet. Any comment or help would be greatly appreciated. Thank You!
Sherry, unfortunately, most MetLife disability insurance policies provide for a set off for any social security disability payments. Please check the FAQ section of our website for additional information on overpayments.
I have appealed and just found out my appeal was denied after 180 days and now have to file a civil action against Metlife, for the following Illnesses: Multiple levels of Severe DDD in my lumbar and theoratic areas of my spine and issues with my cervical, Fibromyalgia, Severe Rhuematoid Arthiritis, Degenerative Disease in both shoulders and both knees, severe chronic pain, Generalized depression disorder, Anxiety disorder and Post tramatic disorder and an asthmatic in dealing with all this, how much can a person handle. I have 4 doctors states that I am disabled and cannot work and Metlife still denies my claim due to their Independent physican’s opinion. I am laying down most of the time as I cannot sit, walk, stand for any length of time without being in crucial pain all due to an accident because a stupid farmer refused to have lights or reflectors on his farm equipment and using it when it was pitch dark out, almost lost my life over it as I crashed into the manuer spreader at 50-55 miles per hour then have to deal with an total dishonest Insurance company as Metlife is! I really need help! I am only 43 years old, I have 2 teenagers and a husband and all they want is their wife and mom back.
Hi, I am 54 years old. I have severe Fibromyalgia. I had been on LTD from my job via MetLife. After two denials MetLife assigned me an attorney and I was awarded disability in Sept 2010. MetLife had said in Nov 2009 that I was approved thru 2023 as long as medical supported. Immediately upon informing MetLife of the favorable decision from SSDI (two weeks), they initiated a “review” with their “independent consultant”, who has never examined me. Even though my Doctor stated I could not hold gainful long term employment , they said I could work eight hours sedentary and closed my claim immediately. It was also determined by Met that they still owed me a monthly benefit, then came the “review”. I am currently in an appeal but even though my Doctors have disagreed with their findings I have learned that there is very slim chance for me. I live in NC. Do I have a civil case possibly?
Jerry, your chances of winning your disability claim are not slim if it is handled correctly. If your appeal is denied, then you definitely have a civil case against Metlife. It is to your advantage and important to have legal representation during the appeal process. Please contact us confidentially via telephone or through our free consultation page in order to discuss your Metlife disability claim denial. You should also take a look at our ERISA appeal and Metlife videos.
I recently had surgery to try to fix a problem with my plumbing so that my wife and I can have a child. The hospital wrote me out of work for only two days but my doctor who did the procedure placed me out longer. I was out of work for two weeks and was informed by employer to file for short term disability. I can’t understand how or who would think that I could’ve worked when I couldn’t but a pair of underwear on for 4 days and was on 500 mg of antibiotics 4 times a day which kept me in the bathroom all day long plus I work on my feet for 8 to 9 hours a day. I was so swollen that I had to walk like a duck and very slow for the first week. I think that it is wrong and would like to find out what I can do can I file an appeal or seek legal action against metlife and my employer.
When I first went on long term disability back in 1999, MetLife would send me a form to fill out, as well as one for my doctor to fill out. At first, these came at two year intervals. It has only been 10 months since the last one we filled out, and they are sending me yet another set to fill out (me and my doctor).
It has always been very clear that my disability is a permanent one, which is getting worse, not better. I was diagnosed with Primary Progressive Multiple Sclerosis, and with this type of MS there is NO remission period. In addition to my MS, I also suffer from incomplete quadriplegia resulting from a car accident back in 1982. Seeing that by now, they must have at least 10 or 12 of these reports on file, I would like to request that the neccessity of these forms be stopped. Please respond to let me know if this would be satisfactory to Metlife Claims Dept.. Thank you very much.
Sincerely,
Brian Garfield
Nathan,
If your claim was denied by MetLife, then they are required to send you a letter explaining their reason and your rights to file an appeal. You must file an Appeal within the time frame they give you. You cannot file a lawsuit until you complete all of your appeals.
Please watch our video on ERISA Appeals.
Since you are seeking benefits for a very short period of time, this is a claim that would not be cost effective for you to hire an attorney.
Brian,
MetLife can request the forms as often as they like. In your case MetLife is probably requesting the forms again as you have a new claims examiner and the claims examiner did not bother to do a detailed review of your file.
You should send a letter explaining that it is a burden for you to get these forms and ask them to reduce the requirement for an APS. Most carriers will require the form at least one time a year, but in some cases they can eliminate the need to send an APS completely.
I am on disability with MetLife and also social security. I just got married. Will that marriage effect my amount I get from MetLife?
Kathi,
Congratulations on your marriage. A marriage should have no impact on your disability benefits from MetLife. If you have kids, then social security may pay you a benefit for your child and MetLife will deduct the benefit you receive from Social Security disability.
I’ve been on Total and Permanent Disability for almost 18 years with many auto-immune diseases. My employer happens to be MetLife. Can they turn around and deny me benefits after receiving it so long? I’m a few years from retirement and I thought you might want to know that MetLife employees under their LTD plan benefit – if MetLife deems me able for gainful employment in this economy that the job must be able to give me at least 80% of my MetLife pre-disability earnings if not then I am still considered disable. Are you aware of this?
Ari,
MetLife has the right to deny your disability claim at any time. If you continue to have strong medical support, then it is unlikely that you will have any problems.
I have been on an employer sponsored MetLife LTD plan for 16 months. I have had 4 different case managers during this period. I just received a call to advise me that MetLife is requesting another set of documents from myself and my doctors. During this conversation I was able to find out that I now have no case manager. It appears that the turn over at MetLife for case managers is high. The problem is I have to go through this with every case manager change. MetLife must retain these files, can I request a copy of all the files they have regarding my case? If so, who do I submit the request to?
Frank,
You can send your request in writing to MetLife, but they may not give you anything since your claim has not been denied.
I am currently receiving LTD benefits from MetLife through my employer, and have just been approved for SSDI benefits. The MetLife LTD benefit will be running out in Oct 2012 according to their “mental†clause of 24 month maximum benefit period. Do you think I will have chance to win the case if I decide to fight with them since I’m still taking medication to reduce my anxiety/depression? Thank you very much!
Minmin,
If you are disabled exclusively by a mental disabling condition that is clearly limited to 24 months, then there is no basis to challenge the MetLife 24 month mental nervous limitation. If you have other physical conditions that prevent you from working, then you would want to challenge the 24 month limitation.
I was approved for benefits and paid for a number of months before my insurance company terminated benefits. I submitted a timely appeal which they have had for 71 days. They have neither provided me disposition nor advisement of extension. My claim is low dollar value so I can’t engage an attorney. Any thoughts on what to do next?
Steve,
You need to sit tight right now and wait for a decision. They should make a decision any day now. It is no unusual for MetLife to blow the appeal deadlines. If your appeal is denied, you should contact us and we will see if we can help you to recover benefits.
MetLife is happier than a tick on a fat dog because they are busier than a one legged cat in a sand box doing everything in their power to thwart my efforts of getting disability insurance benefits.
I am more confused than a hungry baby in a topless bar as to how they can justify this humiliating and degrading treatment of a disabled person.
I would rather have jumped naked off of a 12-foot step ladder into a 5-gallon bucket of porcupines than to do business with the perfect example of an evil empire called MetLife.
I know sure as there is a hell and it’s not freezing over that I am not the only MetLife client madder than mosquitoes in a mannequin factory about their shady questionable business tactics.
This has taken a toll on my nerves, tested what little patience I have left, raised my blood pressure, and taken my stress to an entirely new level. I just want them to pay me my disability benefits.
My question is similar to Brian’s above.
I’ve been on LTD for 10 years (high level SCI) and would receive forms every year around Nov. I also receive forms from a different carrier at the same time for a DIP. This year I didn’t receive forms from either company, so I called them. The DIP Co. said they sent me the forms in late Oct. so they resent them. MET said they had no record of sending them but looked like they would go out in a couple weeks. So I made a doctor appointment for early Dec. and took the DIP Co. and a blank MET physcian statement (I make copies, because there usually same form every year) to the doctor to fill out. In mid Dec. I still hadn’t received anything from MET, so I called and the Case Manager said they would be going out 12/21. Last week I still hadn’t received them, so I called them and the CSR said they were on hold but he would request release on them. This is also the fourth PCP (three different locations) I’ve had with the same diagnosis/prognosis.
The question is, does the LTD Co. ever stop sending forms?
I was approved for Social Security, MetLife has been paying me $1700.00 a month. I was awarded @1180.00 a month, they sent me a W-4 in 2010, so I am actually claiming the money they want me to pay back. For the last two years they have overwhelming me with signing paperwork, not knowing what I am signing. I got it for stress and anxiety, my medicine has been changed about 10 times, so half the time I did not know where I was at. In 2010 they reported my disability as wages, so now they have to send a letter to social security to prove I did not work. Why should I pay back money I claimed on taxes? My rep. said today I could amend them 2011 too, which cost $400.00, they claim they wont pay. I am so lost in the process, I dont know what to do?
Greg,
Most disability carriers send forms at a minimum of once a year. If the carrier does not ask you for any documentation once you are on claim, then you usually not obligated to send them anything. MetLife does a lot of their disability claim handling out of India so it is not unusual to see long periods of time go by with a request for anything. You don’t need to chase them for claim forms. You need to make sure you continue treating with your doctor at least 3-4 times a year.
Sheila,
Your MetLife disability policy may have language requiring you to pay back any funds received from SSDI. With regard to tax implications you need to consult with an accountant.
I was on LTD for 11 months, then my benefits were terminated. I submitted a timely appeal which the insurance company has now had for 130 days. I have received no formal communication from the insurance company except acknowledgement of receipt of my appeal. Any idea why they would delay so long? Is this normal? What would you suggest at this point? Thanks.
Tony,
130 days is an unacceptable long time, even for MetLife. Your only option at this point would be to sue them. Otherwise you need to wait. We have sued MetLife if they take longer than 45 days. At this point you should wait another few days and then decide how you would like to proceed. Give us a call and we can discuss your options.
Gregory, I had worked for Home Depot. In 2010, I received short term disability from MetLife. Six months later, I went on LTD through MetLife. They required me to apply for SSD, which I did. I was granted this 3 months later. I received back money from SSD. At that point, MetLife wanted ALL of the money they had paid me from the LTD policy, which was around $5,000. While my policy says that “some incomes” are offset, it does not specify SSD. What about all the premiums I had paid to MetLife for many years? Was it worth nothing since I will get nothing from them? If this is the case, shouldn’t all employees from Home Depot be advised against taking this policy since they will receive next to nothing if they qualify for SSD?
My husband became disabled through a motorcycle accident (amputation), however he had MetLife. After a two year argument with MetLife he finally began receiving his Long Term Disability payments (and back pay). After about 9 months they began reducing the amount by a thousand dollars, now they have put a “Rehabilitation” charge on the check stub, without any explanation of what this is. His claims Rep. has changed six times, they are always asking for new “annual” paperwork (every two months). It’s harassing and the reality is, my husbands leg isn’t going to grow back. He can no longer do the job he did prior to the accident (construction), and they have yet to offer him a rehabilitation program. But we’ve put in to the Rehab program over $18,000.00. Is there a cap? Is there something they should be doing with this dollar amount? Has anyone heard of a rehabilitation charge? Thanks.
Michelle,
Some MetLife disability policies have a rehabilitation clause, which is MetLife’s attempt to retrain a disabled person and then say they can go back to work. Participation in this Rehab program must be approved. Regardless of how a claimant does in the program, MetLife will usually deny disability benefits at the end of the program. We would need to see your husband’s policy to determine what MetLife is trying to do to him now.
All I can say is that I will never use MetLife ever again. My short term disability checks are so messed up. Saying that they mailed them…
In Dec 2011 I got 4 checks on the 30th. Amazing isn’t it. Two of them were dated the same day, and the other two were different dates. None of the dates were the correct weeks. I am not waiting on the last week of Dec. 2011 check. Was told that it was mailed 1-3-2012. Didn’t get it, said I had to wait until the 18th and if it didn’t show up that they would cancel it and mail another one. Told today, 1-20-2012, that in 7 to 10 days that they would mail another one.
I would love for the ones that are doing their job at MetLife to not get their check either. This is so sorry. I am having to pay late charges on everything, electricity, water, house, etc. There should be a law. This is the reason that they don’t use direct deposit. They wouldn’t be able to mess with your money if they did.
My brother has a history of anxiety due to stress. He is on one daily medication and is well controlled. He opened his own business and wants to protect himself/family with disability insurance, but was told if he applies he will be denied because he is on a medication for anxiety. Is this true?
Kari,
He may not be denied, but if he is looking to buy disability insurance, then MetLife will likely exclude any claims for anxiety.
I received LTD benefits from MetLife due to depression and anxiety. A little over a month before my claim ended due to a mental limited benefit condition clause of 24 months, I was diagnosed with manic depression which is an exception.
I sent the medical information as required by the insurance company. The medical info was reviewed by an independent medical examiner and I was interviewed by a mental health nurse whom found it weird that the manic episode would happen so close to my claim end date.
My doctor advised me that there was not much she could do because although she responded to the examiner’s report they gave her the impression that they thought I was clever and was trying to continue benefits or it could just be side effects of medications.
Can they really just end my benefits without verifying it is not manic depression? I am currently perusing SSDI benefits. I feel they are doing this on purpose to stop my benefits.
Bobby,
You need to file an appeal of your denial within the timeline that MetLife has given you. You have the right to fight MetLife’s disability denial. Contact us if you would like assistance.
I am on Social Security Disability and have also been receiving supplemental Disability checks from MetLife for the past few years now. They are now requesting copies of my personal tax returns, wanting the past two years and also want the current year 2011 when filed – which is three full years! I asked the rep for the reason needed, and she said to verify that I have not been working.
My husband is self employed and has a problem with “his personal information” being forwarded to them as this is a jointly filed return. I have nothing on the return other then the SSD I receive for myself and my children. I was going to ask my accountant to send them a letter verifying that there is no W-2 income, no 1099 income nor any other income filed under my social security number other then the social security.
I cannot get my husband to agree to release the returns to them. He said it is one thing to request information from me, but this is a joint return and he does not want them reviewing his personal information as it is none of their business.
MetLife states that my monthly benefits would be in jeopardy if they are not sent soon. What is your thoughts on this?
Sick & Tired,
You can submit the return, but blackout everything related to your husband.
Had bunion surgery on my right foot on the 3 of January, everything was going fine until I received a call from a MetLife representative of short term disability telling me that by February 20 my disability claim would be closed. I told him to file all the paper work to the doctor’s office so that the doctor could give them a better view of my medical condition. A couple of day past and he called me again telling me that they had received the doctor’s medical condition and that 3 months and two weeks was too much time for that kind of surgery. The person that called has been instigating me and telling me that maybe I am the one that doesn’t want to go back to work. I told him that my foot is still swollen, I can’t stand for a long time, and I can’t drive because the cast is on the right foot. He told me that this was not a medical reason for me to go back to work. He has been with an attitude with me since the first time he called and rude. This is stressing me out and now I feel mentally and physically worse because they don’t want to pay my disability and I need the money. I would like to go back to work but its not my fault that I haven’t recovered at full. The doctor stated that I can’t stand and need to keep my foot elevated and that I am still not able to go back to work. Please help me.
Gina,
MetLife should have sent you a letter explaining their reasoning for denying your claim. You need to file an appeal in order to have a chance of getting benefits reinstated. We handle STD and LTD appeals regularly, but if you are only seeking another month or two of benefits then we could not assist you. You should file an appeal on your own and have your doctor write a letter about why you cannot work. Also, you may find some of our videos on disability appeals helpful.
My doctor lost her license to practice and it was just her and a receptionist. This all happened while I was out of work on short term disability. Now she is the only person who can fill out my paperwork.
I have since returned to work. However I haven’t been paid in 1, 1/2 months now. Me and my family are scrapping by trying to go to different doctors with my medical record and trying to get them to fill it out. They say that since they weren’t the physician who was treating me they can’t fill it out.
I had spinal fusion and I re-injured it in January by falling of a ladder, and it is all in my record, including the note on her office door that she is suddenly closing her office. She filled all my paperwork out for a disability in January and I tried to return to work after a month but after a week and a half I kept having issues with it. So I went back off work on FMLA then MetLife called my doctor after the first few days I couldn’t move around and when I got the receptionist she said the doctor is closing her office she is not here. I inquired more and found out she is loosing her license.
I am now back to work but I was out for a month and a half and I haven’t received a paycheck in over 8 weeks. I’m down to nothing. If you have any advice for me, it would be a great help to me and my family.
Thank you.
Lucas,
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I think you need to keep looking for a doctor to complete the paperwork. You can obtain the medical records from all of your treatment and submit the records without completing the Attending Physician Statement. You may want to try a walk-in urgent care clinic.
I have been getting long term disability from MetLife for 5 years. It started with terrible back pain that radiates down both legs to my feet. It became unbearable and I would, at times, have to see myself to the restroom at work so that I could sit on the floor and cry like a baby.
I ended up having spinal fusion surgery on the L5-S1 area and that is the point at witch I stopped working. The pain persisted but now there is an unpredictable weakness in my legs and a sharp shooting pain that causes my legs to give out without warning. I take strong medication for pain and some for the depression and anxiety the situation causes me.
MetLife recently sent me for a functional capacity evaluation and then terminated my claim. I made the mistake of keeping my composure during the evaluation like I always had to do at work. I did not openly weep or make moaning or groaning noises and I gave it my best like I was asked to do. They turned that hour of testing into the decision that I could work 8 hours a day, 5 days a week. I am 2 days into my claim being shut down and am devastated. I have a wife and 12 year old child. I have pride and dignity and hate not working and providing and having severe restrictions, but it is what it is. I was ready to die before I stopped working if something didn’t change, and it did, I stopped working and being tortured by doing what I cannot. And now?
Brian,
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MetLife’s denial of your claim based upon the results of a Functional Capacity Exam is ridiculous. Your performance during a 2 hour test is not representative of your ability to work 8 hours day for 40 hours a week continuously. Please call us or complete our free consultation request form and we will be happy to discuss your appeal options with you.
I have been on long term disability with MetLife since 1989. I am planning on filling for social security retirement benefits at age 62 (not SSD or SSDI). My policy states they have to pay me ’till I am 65. Can they reduce their payments to me because I file early for social security?
Greg,
MetLife usually reduces for any type of Social Security Payments so it may not make sense for you to take social security retirement. Without seeing your policy there is no way for us to give you a better answer. Also, you may want to send MetLife a letter and ask them your question.
I’m on LTD with MetLife, and probably will be on LTD with MetLife for the next 10 years. I was turned down for SSI, what I want to know if I wanted to sell my LTD benefits with MetLife for a lump sum, do they do this and if so how does it work? With all the complaints I see with them, I would want the freedom of not having to deal with them, or what do you think I should do? Thanks.
Bill,
As of recently, MetLife has not been interested in lump-sum settlements of group disability policies in an undisputed claims. If they deny your claim, then it is likely that a lump-sum offer could be offered as a possible resolution.
Hello, I was working at Bell Atlantic (now called Verizon) and was covered by MetLife for long term disability when I got sick – chronic fatigue syndrome, fibromyalgia (CFS/FM). With those came secondary conditions of migraines, numerous allergies to plants, animals, dust mites & many others, asthma and depression. I didn’t have any of these conditions – not even the allergies or migraines – before I became sick with the CFS/FM.
I applied for long-term disability when my company’s short-term ran out. I never expected all the duplicity from MetLife. When I got denied, I tried fighting MetLife on my own, appealing each denial in a timely manner. My primary physician was fantastic – he was with me all the way and supplied all the office notes, his own letters to them declaring my disability and inability to work, talking to them on the phone etc. Other doctors provided information to support my condition, too, but I continued to get denied.
Once I had run out of appeals, I found an attorney who specialized in employment law. We did everything that was required within the time limits allowed, but, when it came to what we were told was the final step – arbitration – I lost on the grounds that I am a smoker. The conditions that could be related to smoking – asthma, sleep apnea and allergies were all secondary to my primary medical conditions of chronic fatigue syndrome and fibromyalgia.
Before the arbitrator made his decision, as everyone sat at the table, MetLife had offered me a small settlement, which was supposed to cover me throughout the rest of my life – I had to refuse it and my lawyer agreed with me but of course we both wished afterwards that we had accepted it. Hindsight and all that… The arbitrator’s decision occurred in 1994.
Jackie,
Thank you for sharing your experience with MetLife. We are sorry to hear about the negative outcome of your long term disability claim. While your claim was in 1994, most long term disability cases are now handled in Federal Court and not via arbitration. Arbitration can e very expensive and it is hard to find an arbitrator that understands disability insurance claims.
MetLife terminated my long term disability after paying me since 2007. In the records I received from them, it states my initial approval both their independent physician and customer service rep. agreed that I would not need it functional capacity due to the nature of my illness and approved me for my max. duration until 2028. Now they have terminated me based on their reviewer sending a letter for my non-primary physician to answer to based on a secondary illness. When I asked for a copy of that review letter they refused to give it to me; once I received a copy of it I realised their description of my job duties did not match my job description that they admit to having in my initial approval. They state my job was office-based and physical demands were nil. My policy says I would have to make 80% of my income in my own industry and the job description they gave does not fit what I was doing. I find it interesting that MetLife terminated they claim at the exact time they were fined 500,000 million dollars and had to repay SSI. The same week that he terminated my claim they also close down their mortgage division because they were unable to make money in that industry. That happened to be the same industry I previously worked in. I have been diagnosed with severe fibromyalgia and fatigue and my doctors are amazed they terminated me. They based their termination on a secondary illness again not given to them by my primary doctor. My appeal decision is due this week and should they denied me I’m going to need help in filing a claim or lawsuit in federal court I have been seen by multiple different specialist that all agree with my diagnosis and the fact I am unable to work.
If you have any advice please let me know.
Thank you,
Kelly
P.S. I feel it’s a huge conflict of interest that they have somebody not specialised in my illness sitting at a desk terminating my claim in their best interest.
Kelly,
Time is of the essence in your situation and your appeal is extremely important. We would like to speak with you immediately so that we can assist you in submitting a strong appeal. You only get one opportunity to submit a strong appeal. Please watch some of our videos discussing ERISA Appeals. Pursuant to your request we will contact you privately to discuss your claim options. It is to your advantage to have an attorney involved during the appeal process, rather than to wait and see if you can win the appeal on your own.
Attorney Dell,
I am writing you because I want to know if you can help me obtain a LTD buyout with MetLife. They have not asked me for one but I am tired and burned out from them following me, calling me and my doctors. The massive amounts of paperwork I get every other month is causing me to get sicker. I suffer from a brain injury and this is just too much for me. I can’t take it anymore!
Tasha,
If you have a MetLife Group Policy from your employer, then it is highly unlikely MetLife will offer any kind of buyout. If you have an IDI policy that you purchased, then a buyout would be an option. We can help you on a monthly basis to manage your claim. Contact us if you would like additional information.
I have multiple medical conditions, among them CFS, Fibromyalgia, spinal stenosis, degenerative disc disease, and spondylolisthesis. My policy limits payment for CFS to a certain period of time. After a long battle, Metlife paid on the CFS portion but is denying beyond that stating that my covered conditions related to my back, are not severe enough. How do I establish that if we could play the game of “make believe” and pretend my only condition is my back and that is severe enough to establish disability?
Steve,
The self-reported pain limitation in some of the Metlife long term disability policies is very restrictive. Your question is complex, but it is an issue that we deal with on a routine basis. There are numerous things that can be done in an effort to reverse the denial. In order to determine how we can assist you, we would need to immediately review your denial letter and long term disability policy. Please contact us privately and we will be able to tell you very quickly if we can assist you.
My husband has ESRD and recently got a transplant in June 2012. Last month my husband got paper work to fill out to continue his LTD. There is no way my husband can work, even though he got a transplant he has suffered so many other problems in the last few years. He had surgery on his neck 05-31-2012 for spinal stenosis, my husband can barely walk, major balance problems and he falls a lot, he also has very little use of his hands can not tie his shoes, button his pants, zipper zippers. He is always in so much pain. The spinal surgery did nothing to help him gain any function back. He sees a pain management doctor but all the drugs and he is still in so much pain. His neurologist diagnosed him as having idiopathic peripheral neuropathy, his orthopaedic doctor says he has spinal stenoisis, degenerative disc disease and he also has herniated discs and bulging discs. When we filled out the papers he had his Kidney doctor fill out one of the doctor statements and his neurologist fill out another. We would have liked to have his orthopaedic doctor fill it out to, but we did not have enough time to get all his doctors to fill it out (we had less then 30 days). I am worried because I see that Met Life has denied many claims for peripheral neuropathy and that is basically the only diagnosis beside the ESRD and recent kidney transplant. If he gets denied would you consider representing him for an appeal? I can honestly say there is no job my husband can do.
Vickie,
You can still get the other doctor to submit an APS form even though Met only gave you thirty days. We will review your husband’s claim at anytime to determine if we can assist you. We represent hundreds of claimants prior to any claim denial, which can often help to prevent a claim denial. Give us a call at your convenience.
I have worked for my work for over 4 years. During working for this company I learned I have bipolar, anxiety, and depression. I have gone out of work about 4 times for the same reason always having issues but getting them approved. This time I opened a claim and let’s just say they said I didn’t; they reviewed the call and eventually opened the claim 2 weeks later. Then after calling for 2 weeks everyday to get info and see what I needed to do, then denied my claim. Saying I am not disabled, my Dr. did not give me the option to go back to work. I have been diagnosed with these and never had issues before but now all of a sudden I’m not disabled in MetLife’s eyes, even though I cannot do daily tasks and am on over 5 medicines for this. I am to the point I am lost and don’t know what to do. MetLife has put me in a deep depression.
Jennifer,
You will need to file an appeal of your MetLife disability denial. Your disability policy should tell you the time frame within which you need to file an appeal.
I have short and long term disability insurance through MetLife. I had to have a 4 point fusion on my wrist due to an injury I incurred. They claim to determine eligibility within 10 days of surgery. It’s now been 5 weeks. I filled out the statement of health form, sent all Dr. statements etc. to them at least 3 different times. They claim because I took Zoloft for anxiety for a short period in 2009 and that I have carpel tunnel that they are denying me coverage. I did take Zoloft for a short period of time 4 years ago for anxiety and I never had carpel tunnel.
Now they say they will go back and reevaluate my claim. I have bills to pay and this situation is causing me a great deal of stress.
Marilyn,
It would appear MetLife is trying to deny your claim as a pre-existing condition. Please feel free to contact our office to determine how we may be able to assist you in appealing the decision.
After 26 weeks of STD from Sedgwick, my disability continues while MetLife denies my LTD they say due to pre-existing conditions. They already said that I would be receiving 4400.00 per month till age 65, then changed their minds. I now have to undergo a Laminectomy and am about to run out of state disability. Please help me.
Larry,
Please feel free to contact our office to review your information. However, if your claim does fall within the parameters of what constitutes a “pre-existing condition” under the policy there may be very little that can be done.
The beginning of March 2013 my Dr. put me out of work on STD due to pain in my L4 L5 bulging discs. I couldn’t bend or lift anything. I was out of work till beginning of June 2013. I was paid benefits for the duration of my leave which was the max ten weeks. I returned to work with no back issues at all but I had some pain in my pubic area. The situation I’m dealing with now is I’m expecting and got pregnant back in March. I’m now seven months pregnant and was diagnosed with symphasis pubis dysfunction. I can barely walk, I’m in constant pain and my pelvis pops and feels like its falling apart. I had to stop working in August because I couldn’t stand the pain. I filed a claim with MetLife for the symphasis pubis dysfunction and they denied it stating its related to my previous claim involving my back. Because I only have STD they were only able to pay up to ten weeks and you have to be at work for three months before you can receive benefits under std for the same condition. My Obgyn and myself have explained to them this has nothing to do with my bulging discs and is directly related to pregnancy. I feel they’re trying to find any reason not to pay. In my Obgyn records she noted some back pain, but that is only a result of the pain radiating from my pelvis. I know the difference between bulging disc pain and pelvic groin pain. So as it stands I’m still waiting for results of the appeal but so far MetLife said they don’t gave enough info proving it’s not related. I’m so frustrated and stressed. They are clearly two different diagnosis.
Elisa,
I think your synopsis in right on point – they’re just looking for a reason to deny. In the event your appeal is denied, please feel free to contact us to determine how we may be able to assist you.
I just received a letter from MetLife denying my LTD claim for benefits due to a 24 month lifetime maximum benefit period when my disability falls under the “for disability due to Neuromusculoskeletal and Soft Tissue Disorder” provision that seems to be common. I have been diagnosed with Sherman’s disease, resulting in premature degenerative changes at multiple levels of the thoracic spine and ankylosing spondylitis, and I am positive for the HLA-B27 antigen. I have recently been approved for SSDI benefits resulting in the Dr. at the administrative judge hearing also diagnosing me with Sherman’s disease and degenerative disk disease with nerve root compression and distribution of pain by sensory loss. I have not worked for over two years due to the extreme pain in my thoracic back and the multitude of medications that I am on. I am wondering if I have a leg to stand on or what?
Neil,
Please contact our office to discuss. There might be a way to make an argument around it as the MetLife limitation usually has an exclusion if there is evidence of radiculopathy. However, given the nature of your diagnoses as falling within the limitation and if the policy grants discretionary authority, it might be a very tough battle. Nonetheless it is one to look into.
I have an AD&D policy they bought from MetLife. I recently got hurt at work and lost most of my vision in my left eye. I went through 3 months of treatment and no progress, I worked for Kroger and now they tell me I can’t come back to work because of my eye sight. I was 20/15 and now I’m 20/400. MetLife denied my claim at first, so I appealed it. It’s been 3 months and every time I call they tell me to call back in a week. Is there a time frame of when they have to tell me something? I’ve been off work for 3 months and I need my policy money.
Shad,
Time frames are dependent on whether your policy is governed by ERISA or not. If it is, then there are set time frames in which they have to render a decision. Was the policy something you bought from an Agent or procured through your employer?
Here is a MetLife disability claim that will blow your mind.
My wife became disabled and received SSDI. MetLife wanted monthly updates even thou the disability is forever. She called in to their nurse every month. Then out of the blue they said over the phone (they never sent anything by mail its over the phone) that her doc. said she was now ok to work? Then they called her doc. And told them she is able and wants to return to work (not possible). All of it lies, they lie to her then call her doc. And lie to them.
Then when confronted with their lies, they send her off for a medical exam, the one you go to before you return to work so they can make sure you don’t hurt yourself trying to return to work. Its a 8 hour test, so she brought her doc. Restrictions with her they looked at it and sent her home right there. MetLife never sent them her restrictions? MetLife got mad and called the clinic that does the test and they told them that there test was for recovering people not permanently disabled people.
Then MetLife sent her to their doc. (this started on year 6 of disability); it almost ended with an ambulance ride as he told her to lay flat on the table. Due to all the lies MetLife told she told them to never call again. Anything they need or want better be in writing. Now 5 years latter, 11 years on disability they call on the phone and they want updates on her disability. She will not call them. So can they cancel a claim if you refused to update your claim over the phone?
Dan,
First and foremost, I am sorry to hear about your wife’s struggles with MetLife. As for MetLife’s ability to terminate the claim – it is not unheard of that you request all communications, to include requests for information, to be put in writing. I would even suggest that you send the request in writing to MetLife so as to create a paper trail. MetLife can obviously terminate a claim for failure to receive information required to make a claims determination, so make sure to cover yourself by creating a paper trail with them.
I have been on disability from cancer and its treatments for close to 24 months. I have received LTD from SS and Metlife. SS sent me paper work stating that I will qualify for medicare shortly. MetLife is re-evaluting my continued disability at this time. If I accept medicare, will that alter my MetLife benefits? Will MetLife cancel me?
Jon,
Medicare relates to health insurance, which has no impact on your ability to receive disability benefits. With that being said, regardless of whether or not you receive SSDI benefits, there is no guarantee that MetLife will not look for a reason to attempt to deny your claim in the future.
Kaiser benefit MetLife insurance, Kaiser did not comply to request of medical records, then denied my claim stating I had no disability, even though I have been treating with Kaiser for several conditions keeping me off work, then Kaiser my employer took my job away could not accommodate with my restrictions. The delay of medical records of valid medical conditions, gave Metlife opportunity to deny my case. Even though the lengthly time of lapse put me past the statue of limitations. I have several letters and appeals, which according to one attorney mean nothing.
MetLife and company just don’t have to follow rules put the consumer left out.
My LTD insurer is Metlife. I have a group LTD claim that will pay me until age 65 unless I am terminated before the max. benefit duration. I have been on claim now almost 4 years. MetLife contacted me once in 2012 in Oct. via USPS and sent me an APS to be filled out by my psychologist. I have a rare group policy with no 2 year cap on mental health like most group policies. After my psychologist filled out the APS, I was approved for continued benefits. I thought I would get the APS yearly since this was all I had to fill out and submit in 2012 for 2013. It is now almost December 2013. MetLife has not contacted me or sent another APS for my mental health doctor to fill out for 2014. They have been paying my claim however with no problem. I am also receiving SSDI, and my LTD is being offset by my SSDI. My question is why hasn’t Met contacted me yet? They don’t seem to be aggressively risk managing my claim which makes me happy. I see all my doctors regularly, so I have no problem proving continuing disability.
John,
As long as the check is coming, no news is good news. I would not contact them to inquire as to why they haven’t sent you a form. It is MetLife’s job to investigate a claim, so as long as the checks keep coming I would not worry about it.
I had a Pulmonary Embolism and was admitted to the hospital on Sept 30th and released Oct 4th. My GP sent in medical info for my claim requesting time off until Oct 20, which I agreed to. Once I went back to work I continued to have health issues related to the PE as well as new health issues related to the medication I now have to take. However, I continued to work until I just couldn’t so I went back on leave Nov 14. with my Dr. approval. We asked for approximatly 8 weeks starting Nov 14th – Jan 10 and my Dr. has provided all my updated medical documents from my weekly visits. I’ve been told that more medical info is needed and that the nurse representing MetLife has to call my Dr. to get more information although the Case Manager has already spoken to my Dr. I was told on Dec 9th that my claim was approved from Nov 14th – Nov 18th and more medical docs are needed to pay me for the additional days. When I call MetLife I can’t get the Case Manager on the phone so I have to leave messages and maybe I will get a call back the next day. I feel like they are stalling and trying to find a reason to deny my claim. I tried to recover and work at the same time, but it just became to stressful and now that I actual need to take advantage of insurance that I am entitled to for a legitimate health problem I am being mistreated. Do I have any rights and is there anything I can do about this?
Miya,
Unfortunately, if MetLife has not blown any deadlines to render a decision or denied the claim at this point then there is little you can do but wait. I would recommend that you follow up with them in writing so you can create a paper trail as to your inquiries. Please feel free to contact our office to discuss your claim further.
I was hospitalized for 4 days in may 2013 due to asthma and allergic rhinitis. After my release I was advised to follow up with my PCP before returning to work. Thus far, my it was found that I am suffering from anxiety and depression, chronic sinusitis, gerd, and gastritis, as well as a whole host of allergies. During the whole course of these illnesses met life delayed approvals which delayed my ability to be paid by my employer however I was paid until October 13th. My final issue came when my PCP submitted my paperwork for disability in October advising that a return to work date would be established upon my follow up visit in the end of December or beginning of January. During the interim I had to see a psychiatrist, gi specialist, lung specialist, and ent specialist. Upon seeing the went, it was found I had to get sinus surgery, this has delayed my ability to see the psychiatrist and lung specialist. Met life denied my claim 12/12 stating that even though the PCP has indicated that I am unable to return to work, the notes are insufficient. I also advised them that I underwent surgery, they advised that the surgery is not relevant to my claim. Currently I am awaiting appeal paperwork. Any advice would be greatly appreciated. As this denial is putting my employment jeopardy.
Sophie,
I would refer you to all the information on our website as to the importance of filing an adequate appeal. Please feel free to contact our office to discuss how we may assist you.
I had a cervical fusion on one of three herniated disks in April of this year and have been on LTD through MetLife for the past 4 months. They told me I was approved for the next 2 years, however now they are saying they need a statement of limitations and restrictions to continue my LTD. No one will give me a physical since I had spinal surgery and am still in too much pain to attempt the lifting, bending, and twisting that would be required.my surgeon refuses to handle my LTD paperwork since I am no longer his patient. Please advise. I have done everything they have asked of me, but am at a loss as how to get them the documents they are asking for.
Amy,
Metlife never guarantees that you will be paid for a two year period, rather they are saying that you may be eligible for the next two years. Your surgeon is not being reasonable by refusing to fill out the paperwork. You are required to have a treating physician. You may want to ask your surgeon for a pain management doctor recommendation. This new doctor could then complete your paperwork. Contact us privately and we may be able to recommend some doctors in your area.
I placed a claim with MetLife over a month ago. I had a hysterectomy in July then experienced Post Depression Syndrome. Have been seeing so many drs on the regular. Now I finally submitted all my paperwork Dec 1. I got back a letter asking me if I filed my taxes the last 2 yrs. Why? I didn’t do my taxes the last 2 years from the lack of funds and I owe. I explained that to the representative. Then he asked for a letter from my accountant stating I didn’t file as well as signing a 4506. Is this legal?
I expressed my concern about the ridiculous paperwork they want. I live in CT. I have had so much aniexty and panic attacks already and with this I repeated to MetLife that they are driving me crazy. Originally they would give me an answer within 30 days. I should be paid! I appreciate any advice.
Thank you in advance!
Cynthia,
Typically, in order to calculate your monthly benefit, the carrier would need financial documentation to verify earnings. It is not uncommon for them to request tax information.
Hello, I am seeking information to file a class action lawsuit against MetLife. I have been disabled since 2010, initially going out on disability via STD at first. Through all my trials with obtaining and securing my LTD payments I was finally approved on September 2012 by MetLife via my company Schlumberger. I purchased a plan that allowed me to increase the amount of my LTD payout by 10% if I paid an additional premium per month. I paid for this insurance for a while, but as most companies do a merger or acquisition happened and my company was sold to National Oilwell Varco. Well, before the acquisition had taken place I had paid into the plan, I went out on Short Term disability 3 months before the final acquisition took place and was being paid STD by MetLife on my Schlumberger plan. Now being that I went out on disability before the acquisition I was considered an employee of Schlumberger and not NOV so all conditions applied, even the payment of the additional LTD buy up option I had, which was being deducted from my STD payments. In September 2012 I begin my Long Term Disability, to which MetLife handled everything as far as my payments. I was initially told that my payments would be around $3200 by my representative… Well that wasn’t the case… Under my policy with Schlumberger I was to be paid 60% of my monthly salary. Now this amount came to about $2300.00. I immediately advised MetLife that I had purchased a Long Term disability buy up option, which warranted me an 10% increase in my LTD benefit. My Case Manager stated that she would look into it and then make the adjustments and follow up with me but until the determination I would be paid at 60%. I said okay I didn’t have a problem with that as I was confident that I would receive my additional pay. Well after 6 months of waiting MetLife came back and said that I did not qualify for the buy up even though I paid for it. I asked why and she said because of my employer Schlumberger’s clause. I immediately called my LTD case manager at work(Schlumberger) and she informed me that she would send documentation that I was due it. Well My employer and MetLife went back and forth and MetLife never paid me… My Case manager with MetLife Kathy Finneran told me that although I was due it MetLife denied it as due to my employers policy and to appeal it. Due to my illness and the emotional toll I told her that I was to tired of fighting with MetLife and going back and forth with all the redundant paper work and I was done I would take my $2300.00 but my case Manager encouraged me to fight it and she would see what she could do on my behalf. Well after speaking and working with her for 3 more months on this Long Term Buy Up option out of the blue I received a Lump sum payment from MetLife with a description in black and white that I was being awarded my LTD Buy up option payment which dated back 9/2012-7/2013 in the amount of approx. $4,200.00. I then received 3 subsequent checks with the 10% increase taking my monthly benefit to the correct amount of $2683.00. No this is were it becomes fraudulent on MetLife’s part. I filed for SSDI and after many denials, I was approved by a trial judge. I sent all my information to MetLife and they began their offset process. I said no problem. They were going to deduct the Attorney’s fees which means give me credit for those and then asked me to send the remaining balance of any back pay to them to continue receiving my benefits. Well, I received a bill that stated that I owed them $21,000.00 in overpayment and that they were withholding future payments until I forwarded them my back pay from SSDI. Well their math did not add up. Once, I was approved for SSDI, METLIFE reverted my monthly payment back to $2300.00 a month they took back my 10% buy up option. They then stated that they would pay me $1,110.00 a month to offset my SSDI Payment. This was incorrect, because based on the increased award amount I should have been receiving $1493.00 a month from MetLife based on 70% of my salary. My mom and Aunt put together a detailed spreadsheet along with documentation from MetLife where they paid me the increase and detailed what it was for. I launched another formal dispute and now MetLife is back peddling saying that the money paid to me was a error. That is all they had to offer. I told them how could it be an error when you paid me this amounts for months and then sent me detailed documentation as to the increase in payment. They could offer me nothing further, but call me 10 times a day demanding payment. I have asked them to cease the calls as my BP has gone up several times and I had a panic attack. My mom and I would like to know if there is a lawsuit that I may file for pain and anguish. The unneeded trips to my physician and utter pain it has caused me and my family. MetLife will not correct the issue and reset my pay to the correct amount of $2683.00. They are transferring all my payments to the Offset balance which has caused me to go lacking on medicine and cobra insurance payments. I am waiting on them to send me something in writing that speaks to the denial of my increased monthly payments and they will not send it as they are aware that I keep all documentation and will use against them in a court of law. By my account I owe them less than $8k on the offset. I need an attorney’s advice on how to proceed as my body can’t take much of this back and forth and the only answer MetLife can afford me is we errored now pay us. I conclude that they should pay me as my claim was being extended until 2054 or something like that based on my employers plan, they have to pay me until 65. Your expedient assistance and thoughts would be appreciated.
Erica,
Please feel free to contact our office to discuss your claim in detail, as it would be difficult to address all of the issues you are experiencing here.
Hi,
I need help with a claim that I was denied on recently. This is a foreign language to me and I don’t understand it very well. MetLife denied me because I would not let them have access to my medical records, in actuality it’s my Doctors that won’t release them. Something fishy is going on here and I don’t like it. I don’t have time to go into details, but from what I’ve read, I want to go after them, even if I lose,I was a thorn in their side. I just want to know my rights and NOT be taken advantage of.
Thanks so much for your time.
Sincerely,
Mandie
Hello,
I am an employee of Verizon and I went out on Short term disability due to emotional stress and anxiety. My company gave me a list of people that I could see so I picked the first name on the list. This person is a Licensed Certified Social Worker (LCSW) in the state of NJ. She faxed in all my paperwork, and now MetLife says she is not a psychologist so they will not look at the claim! My own company referred me to her! And on the letter MetLife sent me when I was out, it says have your Doctor or “Qualified Practitioner” fill out the medical history. I asked them what they mean by qualified practitioner and they say psychologist or psychiatrist, however clinical definition of LCSW can also prescribe! What do I do?
Thomas,
It might be wise to start treatment with a Psychologist or Psychiatrist in conjunction with your LCSW. I am of the opinion the LCSW is a Qualified Practitioner, but with that being said MetLife would most likely look to trump any opinion of the LCSW with that of a Psychologist or Psychiatrist.
My surgeon sent MetLife a restrictions and limitations form stating zero on everything from driving to walking, standing, bending, etc. after he had released me to drive and go to physical therapy. I didn’t know he had sent this. No one told me about any of these restrictions, and now Metlife has denied my disability after their investigator filmed me driving and bending over by saying that I was not following my doctor’s instructions. I am filing an appeal. Any advice?
Amy,
If your claim is governed by ERISA, the appeal is going to be the most important piece of your claim at this point. MetLife normally only provides for one level of review, and if the denial is upheld your only option will be to bring lawsuit. Furthermore, after a final denial of benefits no new information can be brought into the record for a Judge to consider. It would appear that MetLife has a lot of parts working against you from a denial standpoint that are going to need to be addressed. Please feel free to contact our office to discuss how we may be able to assist you in appealing the decision.
Do I need to sign over a release form to metlife for my social security medical records? Do they need this information to process my long term disability claim? I have not started receiving social security disability yet.
Dee,
MetLife will have an interest in your SSDI claim file to determine if and when you are awarded benefits. Additionally, if the SSA approves your claim then the information would be important to get to MetLife as evidence in support of continued disability.
I know this is not under your field but I was hoping you could direct me to someone who can help. My dad’s with MetLife since 1988 for life insurance. In 2007 someone with the same first and last name but different middle name and different SSN withdrew money and closed his account. We have a copy of the paper and a verification letter from a MetLife consultant accepting and closing the acct. The other guy wrote down my dad’s account number. I dont know how he got it. I’m trying to get to the bottom of this but MetLife has yet to call us back. My dad didn’t know the account was closed until last year as he’s been living overseas. When my dad first called them to find out what was going on, MetLife told my dad to pay 10,000 if he wants to open the account they closed without his permission. Help, please.
Hannah,
Unfortunately, we would not be able to assist you as the issue is outside our scope of practice. I would suggest contacting your state insurance commissioner and looking into some type of insurance fraud complaint based on the account being improperly accessed.
I fell off my roof 3 years ago and broke both my ankles. The right one has given all kinds of trouble. 7 surgeries and haven’t been able to walk more than a few feet since then, it hurts all the time. I want to have it amputated. I am wondering if I will be able to recieve payment on my AD&D insurance and long term disability? FYI, my work let me keep my job during this time hoping I would get better but now they’ve grown impatient and I can’t do a good job anymore. It’s time for me to go. Every Dr. I’ve seen has implied that the original ER dr could have, possibly should have amputated the day I fell but he didn’t.
Brett,
Without a thorough review of your policies, medical records and occupational information we would not be able to indication as to your ability to collect under your policies. If you have copies of the aforementioned policies please feel free to contact our office to discuss how we may be able to assist you.
I have been dealing with MetLife since Oct of last year. I have a 2 Level Fusion at S1 to L4 a neck fusion at C3. I also have DDD Spinal Stenosis and S1 Joint Dysfunction. I can not sit or stand for long periods of time without major pain in legs and lower spine. My job is a Call Center Rep and sitting for long periods at the time is a major part of my job. Why do they make me give extra info on a condition that will never get much better? I feel as though I am being bullied? My major complaint is they paid me STD for 5 months and then needed medical info with x amount of weeks until LTD kicked in and stopped payment. Hey I’m broke and have no money for medications let alone a DR visit… This has happened in 2 month intervals and then the decide to pay. Much distress when you are unable to work your job due to chronic pain… Please help me!
KLK,
Please feel free to contact our office to discuss how we may be able to assist you.
Here is my problem: in January of this year 2014’i went out on my 6th surgery that I’ve been having since June 29th of 2012. After my last surgey my surgeon told metlife that I was clear to work with no restriction. Then I took an FCE test that said the complete opposite. I have a problem with chronic pain, and I am medicated on narcotics, and have to be medicated to be able to operate. I gave the info of all my doctors including the spine and pain doctor which they didn’t call to verify anything with. My job won’t let me come back on medication. And I’ve been denied. What should I do?
SAMB,
At this point your only option appears to be appealing MetLife’s denial of your claim for benefits, which will be difficult in part due to your doctor clearing you for work. Please feel free to contact our office to discuss how we may be able to assist you.
I just lost my father and asked for a leave of absence. They said I needs a Dr.’s note. My Dr. can’t see me for two weeks. If I keep calling in I can’t return to work without the Dr.’s note. Will I be able to collect disability for my time lost?
Unknown,
I am sorry to hear of the loss of your father. You will need to review a copy of your company’s short term disability policy to see if you meet the requirements for disability.
I worked for Continental/United Airlines for 15 years and paid for long term disability for all of those years. I was diagnosed with type 1 diabetes and could not work because I can’t walk from the diabetic Nuropathy in my legs and hips as well as other parts of my body. I ceased working in February 2014. I was approved for social security diasability but will not recieve that untill the fall. MetLife is supposed to pay me 60% of my pay untill 65 and will deduct ssd payment and only pay that amount to bring to total up to 60%. They are dragging their feet and I know why. They are waiting for SSD to kick in so they don’t have to pay the 60%. My comapnay is no help either. They were supposed to offer reasonable accomodation but, because of almalgamation of the two unions they to have threw me under the bus! I guess it’s true what they say about met life being legalized extortion. And they think organized crime is dead!
Tim,
How long has MetLife had your application? Under the law they are entitled to 45 days to render a decision, with the possibility of a 45 day extension. Please feel free to contact our office to discuss your claim.
I have been on disability for 5 years now. I know that SSI allows you to go back to school, but does MetLife allow it as well? I am trying to see if I can go back to school and work, but I do not want them to yank my LTD benefits when I am not even sure if I can do it.
Christy,
Without a review of the policy there is no way to be able to advise you. Please feel free to contact our office to discuss same.
I had back surgery on 4/15/2014. MetLife approved a shot term disability. My regular doctor says I can no longer do this type of work (grocery cllerk for 35 years) the surgen who performed the surgery says I am fine. Additional problems are rotator cuff injury because of a fall after surgery and PTSD. MetLife is reviewing my claim and even though I have several doctors saying I cannot do this work they are only looking at the surgeon’s statement. Although no one will give me a back to work form. Help me!
Kym,
Unfortunately, it would not be unheard of for MetLife to focus solely on the surgeon’s opinion in an attempt to deny your claim. Please feel free to contact our office to discuss how we may be able to assist you.
Hi, I am on STD. Now, after faxing a ton of paperwork I had a 2 level fussion 2 herniated disc in neck and a morphine pump implanted inside me which I get filled up every month. So I have morphine drip into my spine 24/7. MetLife kept running me around till they finally called my work; they said they did not use my name, they just asked if they would be OK with someone working with this condition which is for life. My work said no they would not allow me back to work so they approved me for the 6 months of STD. At month 5 I am supposed to be in contact with a LTD rep. I see that MetLife is tough to work with. The STD rep even told me not to tell my work I was on pain medication. She said her work doesn’t have to know she is on pain medication. Anyway I think MetLife will give me a hard time.
Is there anything I can do to help my case before having to deal with the LTD people?
I have had this pump about 3 years now and the pain won’t go away as my Dr. stated on the disability form and also said I can’t work any job. Now instead of faxing 2 inches of paperwork they could have called my work in the first place. Should I wait and see if they approve me first before contacting legal help? I want MetLife to know they are dealing with a lawyer right out the gate. Thank you.
Bob,
Please feel free to contact our office to discuss how we can assist you in the monthly handling of your claim with MetLife.
If I am currently out on disability with MetLife and I come down with a new psychological issue/claim, can I file a new claim? The entire two years I was out and receiving benefits I was still paying the bi-weekly payments on my policy through my firm.
Jeff,
If your MetLife policy has a 24 month maximum benefit period for the life of the policy on any disability claim as a result of a mental health condition then you may be barred from filing any new claims if you have already received 24 months of benefits on account of a mental health condition.
My disability claim and appeal were denied. I broke down was out of work for four months dealing with stress, insomnia, panic attacks, and depression. They’re saying that I was physically capable of doing my job, but they’re not taking into account that the job was the major source of my stress and anxiety, in addition to depression I was experiencing. With therapy and a change of diet I was able to sort out my issues and go back to work, but meanwhile I was out of work and had no income (except for a friend who took me in and provided food for me during that time until three months later when I became eligible for and received food stamps). Am I able to sue them after the appeal to force them to change their minds? It’s not fair that I should suffer from these issues and have to be out financial assistance during that time.
T,
You would have the right to bring a civil action under ERISA following the final denial of your benefits.
I’m in the same boat as this guy. It does not list SS as a deduction, it list all the other incomes but SS is not listed.
Mike,
Unfortunately, in almost every employer provided disability insurance policy, SSDI is an offset to your benefit. The purpose of a group disability insurance policy is to provide a certain percentage of prior earnings (typically 60%). As such, the offset is applied to make sure you don’t exceed this amount. The only policies that do not typically contain an SSDI offset provision are privately purchased individual policies that can be purchased from an insurance agent. These IDI policies have premiums that cost a substantial amount more than what you may have to pay for the employer provided policy, and thus cost prohibitive.
MetLife denied may claim in 2008 on my arm and neck. The lady had me fax paperwork to a fax # and it wasn’t right or I was receiving workercomp so they denied paying me and claim said I need to send in all doctors reports since 2008 for claim. In 2010 it was denied again. I was forced to quit my job but MetLife won’t pay long term disability either. They can’t find my life insurance policies on my family I payed for 15 years either.
Mary,
If your claim for long term disability benefits was denied in 2008, the Statute of Limitations to bring a lawsuit may have already expired.
Prudential has denied my claim abd stopped paying benefits stating that I had a pre-existing condition. They paid 3 months of benefits to me and now want repayment. I have not collected any SS disability benefits and it was their error in paying. They paid benefits prior to completing and receiving all the medical records needed to review my case. I do not feel I owe them this money, nor do I have it to pay them. The funds (about $3500.00) was used to pay monthly bills as I was out of work with doctor’s orders. Repaying them would create a huge financial hardship. Can they sue me for the money?
Kelly,
If your benefit was being paid under Reservation of Rights, then MetLife could be entitled to seek a repayment. Furthermore, some policies state that a carrier is entitled to repayment of any overpayment even if the overpayment is due to its mistake. If they have sent you a formalized letter regarding the overpayment and denial please feel free to contact our office to discuss the matter further.
Just received notice that I will not be able to continue my LTD with MetLife beyond my 24 month transition date 10/28/14. I am 66 years old and according to the policy from work since I started collecting at 64 will only be allowed for 30 months which brings it to April 2015. I am currently disabled due to lower back and neck pain and also sacrum pain which causes me to sit no longer than 5 minutes at a time. I worked as an administrative assistant and they say I am able to do sedentary work. How can that be if I can’t sit for more than 5 minutes or work on computer? I know it is only for 6 more months but it is now the principle. Do you think I should pursue the appeal?
Bernie,
I think it is definitely in your best interest to appeal to obtain the remaining benefits. It is incredulous that they would deny the final 6 months. Please feel free to contact our office to discuss the denial of your benefits in great detail.
I work for Verizon Wireless and this year alone has been a miserable one, mentally and physically. Earlier this year in April, I went out for short term disability due to high anxiety and depression, and was dealing with my disabled brother being in the hospital and other things that would intensify my mental stability. My Human Resources director at the time suggested I go out on short term disability in which I filed a claim with Metlife. I was seeing a doctor and was prescribed three different types of medications – all which caused side effects ranging anywhere to severe migraines to sleep deprivation. In that same time, I was also seeing a guidance counselor, who she and my doctor submitted everything to Metlife. That claim was then in turn denied due to stating I did not have enough medical evidence to be deemed out of work. When I appealed it, it was still denied due to the same reasoning after speaking with both my counselor and doctor. I returned to work only shortly to be taken out again due to the multiple side effects of the different medications I was on, yet that claim was approved. I do not know what to do or if I can even do anything now at this point in regards to that claim.
Now I recently went out of work on 10/13 due to suffering from severe migraines. I was out for a month before, which Metlife approved, but in this turn Metlife has notified me today that the claim was being denied due to me not notifying them within 8 days and that I already exhausted the one time I would’ve been allowed to do that. The reason why I was a day late within filing the claim was due to the date that I had called, a representative of Meltife over the phone had advised me that their systems were down and had no ETA for me to call back. With my medical condition, the last thing I want to do is have to call every single hour to file the claim, which was in turn denied. I am currently waiting on the denial letter, but am wondering what or what can I even do to prove their system was down aside from the call history log on my phone to prove I had called and was on the phone for a specific amount of time? To make matters even better, this case manager has not spoken to me since I had filed the claim up until today to tell me it was denied because I hadn’t filed within the 8 days. Please give me any type of guidance as this would be appreciated.
Taryn,
I have honestly not seen a denial based on the scenario provided. When you receive the denial letter please feel free to contact our office so we can review the letter and your policy to determine how we may be able to assist you.
I have been offered 2 years’ salary in severance. I am in the process of applying for LTD benefits with MetLife. Will the severance money be considered a “single sum payment” under the policy and result in a setoff or will I be able to keep both the settlement money and my LTD monthly benefits without reduction?
Jerry,
It may be based on the language MetLife is using for purposes of determining deductible sources of other income. Additionally, I would caution you that some severance agreements are written in such a way that you are forfeiting all rights under ERISA. I would suggest you request that there be an exception placed in the severance agreement that it does not affect your rights under your LTD policy.
My father is on MetLife Long Term Disability, and has been on it since early 2013. He is unable to work due to degenerative back and shoulder injuries, and the injuries require him to be on pain medicine. I know MetLife is known for having a 24 month limit on Long Term Disability, and the two year “anniversary” of my father’s disability comes up in about three months. He is also awaiting a hearing for SSDI, which he filed for back in the summer of 2013 (I’m sure you know the appeal process takes forever). My question is, will my father lose his MetLife insurance once it passes two years since his first check, or is he able to continue collecting MetLife until age 65 (my father is 53)? Thanks.
Sean,
Without better knowledge of the contents of the medical records, occupational history, claim history, etc. we would not be able to provide any educated guess as to the likelihood of his claim continuing. Please feel free to have your father contact our office to discuss his claim further.
I have been diagnosed with Refractory Focal Epilepsy, which means my siezures are not controlled by medication. I started on short term disabilty in 2011 then went to long term 6 months later, in February, 2012. I have been on 10 medications and just had an issue in November 2014 in which my specialist stated in a letter to MetLife that I am unable to drive till I am seizure free for 6 months and I need to see a doctor for cognitive therapy because my congitive functions are weak due to the seizure and long term medication exposure! MetLife is aware of this and before Christmas they sent it over for review and toatly disregarded MY Doctor and Wednesday, Jan 7,2015, they stated I can go back to work! I and also took another seizure on Saturday the 10th. How do they expect me to get there, I am not near a bus line, my Doctor will not release me too work and how in the hell do they expect me to pay for my medications? And according to my HR from where I worked. MetLife is supposed to find me a job and help me, they have not done anything. I can not believe how they can do this and their 833 million dollar profit should be handed out to the needy instead of some ass sitting high on a hill in a mansion deciding where to take a vacation next!
Christopher,
I am sorry to hear of your difficulty in dealing with MetLife, you are certainly not alone. Please feel free to contact our office to discuss how we can assist you in appealing the denial of your benefit. With respect to what HR told you, they did misspeak- MetLife has no duty or obligation under the policy to assist you in finding a job.
My 7 day STD waiting period for colitis was over on 01-04-15, my forms filed the 12th by my employer, and a voicemail message received (and saved) Jan. 28 from MetLife my check was mailed that day, but that contact from MetLife came only after I forced my employer, Bioscrip, to get involved. In the interim, before involving my employer, I received a letter from MetLife indicating my pay rate was omitted from the forms, but no one there seemed to know anything about it hence why I got my employer involved. First, that portion of the form was for completion by my employer whose policy it is to submit the initial STD forms themselves, secondly, it was NOT missing cause I kept a copy and could see it on page 1 of the form. They finally cut a check, held it from mailing till January 31, and was for benefits through 01-26-15, then my second check was for benefits through 02-02-15 and had more forms to be completed by my doctor and returned by February 9; the letter was dated 01-27 and held from mailing so not received by me until 02-02-15. Luckily, my doctor completed the forms quickly and were faxed 02-06-15. I involved my employer again on 02-16-15 because I still had no additional contact or check from MetLife. I was told in email by my employer the forms were received the 10th and that MetLife had 5 days to review them..isn’t the 16th more than 5 days? By yesterday, 02-19-15, still nothing and my employer tells me in email that MetLife just started working on my claim again; also more than 5 days since the paperwork was received. My GI doctor rep has called the Insurance CM, but she doesn’t return calls, including my own. And the supposed confusion with the paperwork is their questions ask what I’m capable of at work so my doctor wrote working 8 hours in intervals, but the fifth and last page asks WHEN can I return to work..he clearly wrote April 15, 2015. His intent was to describe the goals of my remission and provide a date he expects to achieve that, obviously because I have a copy of the paperwork sent.
My employer refuses to provide me the short or long term plan documents, MetLife tells me I have to get them from Bioscrip, and as soon as I gave a complete accounting in email to my employer of all the malicious acts MetLife had committed and all with their permission I was told to stop contacting Bioscrip and referred to their lawyer. I’m in the third week of no money, bills definitely coming due, and no one to help me. I’ve exhausted “loans” from friends in these 2 months, and am exhausted from doing all this. I followed every rule from starting FMLA last year to asking for ADA accommodations (I was told nonexempt employees are not entitled to ADA accommodations), and filing my STD paperwork timely. Colitis is highly stress driven so remission hasn’t even been an option while off, and all sorts of other medical issues have arisen from treatment. If this becomes an LTD claim through MetLife chances are good my family will be burying me.
Julie,
Your company is responsible for providing you with a copy of your policies. I would recommend you send a written request advising them that the policies are being requested pursuant to Section 1332 of ERISA and that failure to provide same could result in civil penalties.
Ok, since Jan 31 of 2014 I’ve been out for surgery. I am from Arkansas and this is how my story goes.
In June 2012 I was involved in a motor vehicle accident. Had 3 surgeries on the spot (knee, hip, ankle, tibia and foot.). On November 31, 2012 I had another hip surgery. This time they did a total hip replacement and I was out on long term disability for all the time.
In August I was was about to loose my health insurance and loose my job, so I was advised to go on light duty for a couple months so I can have my benefits reinstated in order for my upcoming surgery to be paid for. So I worked in light duty from August 2013 to Jan of 2014, when I left for another surgery.
Since then I’ve had STD for a couple of months then they cut me off after one my doctors said I was good to go on his end. But I have hip, knee and back problems that requires me to be under pain management. I have upcoming surgeries that my hip doctor and knee doctor documented and also letter from my pain management doctor advising me to say off of work.
MetLife denied my first request for LTD, then ask me to appeal if I wanted to. So I did appeal and send them all that wanted. And now they denied me again. I was terminated on February 1st and all my benefits along with it.
So now I don’t have insurance and I don’t have a clue what to do next. If there is anything a lawyer can do I would like to take care of this as I just been denied a couple weeks ago.
Samb,
If your policy is an employer provided policy then your only option at this point may be to file a lawsuit, which unfortunately takes quite a bit of time to see to an end. In order to better assess how we may be able to assist you, please feel free to contact our office to discuss in greater detail.
For people who get or are on disability benefits from MetLife: you can stop the calls and harassment with one letter! Send a certified letter saying you want all communication to be in writing.
MetLife called all the time, calling me names etc.. so I ended all calls and asked to be contacted by mail only. They called a few times after but I just ignored the calls. Now I only get the yearly survey, no one calls me anymore. Make them put all contact in writing, don’t answer their calls.
I have been diagnosed with Bipolar Disorder. Previous to this diagnosis, I was diagnosed with Major Depressive Disorder and have been on medication for anxiety/panic attacks since the late 90s.
I was out of work previously from 3/27/2013 – 2/11/2014. Only returning to work because all benefits were stopped and had no mponey to support my family. I also have a claim no for a period of time from 7/17/2014 – 2/8/2015 (current claim denied – waiting to appeal). Also returning to work due to income.
MetLife has denied all claims I have made for these illnesses. I have been seeing specialists, doctors, and councilers for these issues. I was sent a letter during the 1st claim by their Independent Physician that stated because I was clean shaven and did not want to kill myself or anyone else that I was able to go to work.
I have lost cars, been without food and utilities for periods, my credit is ruined, and I owe everyone I know because of MetLife. My current claim was paid for 2 pay periods (4 weeks) and then the rest has been denied. I am at the stage of filing for an appeal.
Is there any recourse for getting my lost income?
Metlife,
I would agree that it is very wise to get communication in writing so things cannot be misconstrued. That being said you do have to be cautious that you don’t miss any imposed deadlines to provide information to MetLife- as it always seems that a letter takes an exorbitant amount of time to reach you.
Shayne,
Your recourse is to file an appeal of the latest denial in an attempt to secure the benefits owed. Please feel free to contact our office to discuss how we may be able to assist you with same.
Having previously commented and questioned MetLife’s claim handling I am of the opinion anyone who has a short and/or long term policy with them governed by ERISA should retain legal counsel before they even apply a band-aid to the wound. Their latest tactic was to Fedex a check to me with notice my claim was closed after March 1, 2015, yet provided no reason or explanation, but I had until March 15 to appeal. So I called them, but they have not returned calls from me or my doctor since I received this notice and check, and I have no idea how to appeal since they provided no reason and did not provide their usual medical update form with the check. My own employer will not instruct me on what to do, and I know from reading the letter accompanying the last check my claim is considered closed as of March 15, 2015. Better yet they told my employer I would return to work March 1, and I received notice of that via email from my employer March 4 then by mail March 11. Hard to appeal when you cannot get a call back from the insurance carrier, and even more difficult if your own employer has told you to only communicate with their attorney on the matter and he, too, will not return calls or emails.
My GI doctor spoke with my MetLife case manager February 27 after my appointment with him for a planned medical update “chat” and made it clear the soonest I could return to work while still being treated for ulcerative colitis would be mid April; how did they turn that in to my being at work 3 days later? I did contact his office immediately upon receiving notice my claim would be closed, and all they can do is leave messages at MetLife; something they continued to do after my March 10 appointment as well. And why do I not have anything in writing from anyone on how this decision was made? All I know is my functional capacity still does not meet the requirements of my job, and that was communicated to MetLife by my physician verbally and in written updates.
How can I fight this battle when I don’t even have an idea what I am up against?
Julie,
Please feel free to contact our office to discuss your claim in much greater detail. If your claim was closed effective March 15 you will have the ability to submit an administrative appeal to challenge the decision.
I am 58 1/2 years old and on longterm disability on a private policy from the late 80s that does not contain any language regarding Social Security and/or offsets for receiving SS. My 18 year old son has just begun receiving SSI due to a congenital disability. I am the “custodian” and overseer of his account due to his cognitive disabilities. Is MetLife likely to be coming after me for any offsets due to my son now receiving SSI and would this be defensible for them?
Molly,
If it is a private policy you bought through an agent, then there should be no offset for SSDI or sources of other income. So, no, MetLife should not be coming after you for an offset. If they do attempt it, please contact our office to discuss how we can assist you.
Hello Attorneys,
I am supposed to be on a 2 year LTD with MetLife, I was receiving my benefits but they were cut exactly a year after, they gave me the excuse of not providing continuous doctor visits during the receipt of my benefits, so I gathered all the information they requested and sent it to MetLife. Now they are re-evaluating and re-evaluating and prolonging my benefits. I have a 10% disability due to and accident while employed. I am tired of waiting on them for, I don’t know what. I call them every day, now it looks like there is a third party agency evaluating my case, so Metlife now is blaming the tardiness on them. How convenient, my benefits will end on Oct/2015.
Ricky,
When the benefit was terminated I assume that MetLife required an administrative appeal of the denial? If so, and your policy is governed by ERISA, MetLife would have 45 days from receipt of the denial with the possibility of a 45 day extension to render a decision. If MetLife is outside of those timeframes please contact our office to discuss what options may be available to you.
I have filed a claim for short term disability which started on 01-21-2015 and per the form my doctor filled out, he put return to work date 06-01-2015. Someone at MetLife decided my claim was going to end 04-19-2015. I am currently going through radiation treatment for triple negative breast cancer and trying to speak with the case worker assigned to me I am getting told that I or my doctor needs to provide more paperwork. Every time I speak with her, it is a round and round, get no where battle other than for her to tell me my benefits are going to stop on the 19th of April. I am still going through radiation treatment and have follow up appts with my radiation oncologist and medical oncologist well beyond the 19th.
Faith,
Please feel free to contact our office to discuss your claim. It is not uncommon that an insurance company determines a return to work date is much sooner than your doctors.
Hey, I filed for LTD with MetLife. I’m in the final stage of getting approved. All doctor information is sent in. My question is, can they denial my claim? I have 3 lower disk bad in my back and one in my neck. The specialist doctor said they couldn’t give me a 50% recovery on back surgery. My primary doctor took me completely out of work and said I can’t work doing no job.
Another question is, should I let them handle my SSI for me or should I go ahead and sign up myself?
Thanks!
TKnight,
MetLife can always deny a claim based on a multitude of factors and situations. Unfortunately, LTD benefits are never guaranteed. We typically suggest you retain your own attorney for SSDI. Please feel free to contact our office should you have any questions.
I’m wondering if MetLife LTD can deduct any monies I withdraw from my IRA for additional income? I thought I had read that they can. Thank you.
Angela,
You will need to refer to your policy to determine what is considered “Other Income” for purposes of offsetting your monthly benefit.
And the joy of dealing with MetLife continues even after my employer fired me on 04-01-15 while out on STD, and that was days after I emailed HR to reapply for FMLA having realized I was eligible again as of 03-27-15.
Now MetLife is sending a doctor to my home this coming Friday (05-01-15) to assess me. Come on people… how do you diagnose ulcerative colitis by taking my height & weight with some blood? You can’t, which means this MetLife appointed doctor will rule my UC as an inconclusive diagnosis, and I still will remain unpaid for the 5 weeks I am still due for STD payments. Better yet, MetLife will deny paying me those benefits again because my blood tests didn’t tell them I have UC. The elevated ALT will just show I take medications that elevate it, woohoo. How does anyone ever get paid by this company?!
I can’t even retain an attorney at this point to fight the ERISA battle, and now I have the termination of employment to fight under ADA discrimination. In a word, I’m screwed. No money, still in treatment, and cannot even file for unemployment because I can’t honestly say I’m trying to find a job since I cannot work. Had MetLife paid me the funds I was due when I needed them then I could’ve afforded my medications and been medically compliant, but no money means no meds. Pharmacies don’t like the Wimpie reasoning of I’ll gladly pay you next Tuesday for my medication today.
Julie,
Please contact our office to discuss your MetLife claim. We may be able to assist you on a contingency fee arrangement.
I have Farm Family disability insurance on my own not with an employer. I filed a claim and it has been denied. They say it is a preexisting condition from before I took my policy out and I should have included it in my application. I was unaware of the condition until end of last year when my doctor told me about it. The doctor has it in his file from a year before I took my policy out. I was going to a teaching hospital so everytime I went I saw a new doctor and they would never tell me anything at those visits. I am now under a different doctors care. I had 2 policies with farm family and they are canceling one policy and putting preexisting conditions on the other. Do I have any grounds to fight this?
Kathie,
It will all depend heavily on the policy language and what the medical records show. If the records reflect the condition being present prior to you purchasing the policy (and it was not disclosed on the application) then there may be very little that can be done.
Hi I need help been pay in for MetLife for years now and I rolled my wheeler one day taken out of work for damage done to my to my ribs could not work my doctor had filed out the std paper work and it’s been go in on 3 months I call every day to see what information that they need and they keep.telling me that they need my doctor information and they can not get ahold of doctor that they try calling witch is b.because doctor says that they have not received one phone call from MetLife or a Fax from MetLife I call leave message s and a week later they decided to call me back.after I call all week they say they left me messages on my phone but nothing if someone could help.me out thank.you
Jesse,
Please feel free to contact our office. The law provides 45 days to render a decision on an application for benefits, with the possibility of reasonable extensions.
My husband has been on LTD with Metlife through his employer since his Aoritc Heart surgery in 2001 which has left him completely disabled. He is also receiving SSI and will be turning 62 this year. Metlife has sent their yearly finiacial inquiries and they would like my ss # and my info because they see I’m 62 or older and need to know how I’m receiving my ss. I will be 62 this year but I’m receiving ssi from my disability since 2009. I had fought and won my 3 year fight for LTD claim with metlife, but after only 3 months of receiving my LTD from them they reveiwed my case and decided I was no longer disabled. After spending every penny we had saved and selling all our assets for my attorney for the 3 year fight I decided I was done and took my early retirement to be done with metlife I didn’t want their LTD after my attorney said they could do this everytime I won my case.
I just can’t see the need or what they could do with my info. As you can see I don’t trust metlife and my husband says he’s not going to put anything down. But the question “Is your spouse receiving ss benefits payable on their own employment record”. Does that mean ssi too off my employment record? Could we say no to that question? I don’t ever plan to claim myself as a dependant on his ss. I doudt your able to answer my question, Metlife seems to have control over attorneys and the judicial system, for them to keep getting away with their consistent dirty tricks, thats probably why no one has been able to get a class action lawsuit against them. My company quit using them as their STD and LTD after all the stress and heartache I had to go through, I was pretty vocal to them and they started researching other employees trying to get or denied their claims and saw the pattern. Too bad other employers don’t see the pattern and hurt metlife where it’ll hurt, no new contracts….
Dona,
MetLife would only be able to offset your husband’s claim if you were receiving dependent SSDI based on your husband’s disability claim with the SSA. As you are receiving benefits based on your own award of SSDI MetLife would not be able to reduce your husband’s benefit.
Dona,
MetLife would only be able to offset your husband’s claim if you were receiving dependent SSDI based on your husband’s disability claim with the SSA. As you are receiving benefits based on your own award of SSDI MetLife would not be able to reduce your husband’s benefit.
How frequently can Metlife Request an IME? I had one done just under 2 years ago that fully supported my claim. Now they are insisting that I see a Pulmonologist in 2 weeks to ensure my condition “has not improved”. I have no breathing or lung issues..?? They refuse to let me see the Rheumatologist that they chose to do the IME last time who would be most experienced in my Fibromyalgia condition. They are also asking for a copy of my SSDI denial from over 3 years ago to “review again”…? They had a copy and reviewed it then.. why would they need to look at it again? Also about 4 years ago they denied my claim after reporting flat out lies regarding phone conversation with my Dr. She responded by writing them a letter, very upset by their inaccurate claims and they promptly reinstated. I really and truly feel I am being harassed by them at this point. What recourse do I have in this situation? I feel that I have to respond to them and provide all information they request or they say they can deny my claim….
Frustrated,
There is no set number of times, unless the policy designates a limit (this is very rare). Typically IMEs are requested 1-2 years apart depending on the specific facts of a case. Please feel free to contact our office to discuss your claim in greater detail.
Frustrated,
There is no set number of times, unless the policy designates a limit (this is very rare). Typically IMEs are requested 1-2 years apart depending on the specific facts of a case. Please feel free to contact our office to discuss your claim in greater detail.
I applied for STD back in May 2015 and gave MetLife everything they needed and told them I am on a reduced schedule and filed my claim. They approved it sent a check and then called me back and said it’s been denied and I need to pay them all the money back. I said I don’t understand why you denied me as I gave you everything that you needed. She said they thought I was off work and I said I told you when I filed claim and all my dr notes state the same thing nothing that you didn’t see that was all in writing. Now they call me a ton of times a day to collect the money and I’m still on a reduced schedule from my oncologist/hematologist until end of November. I am paying all my bills late and my rent and can’t even support my child. I want to sue this company for all my troubles and time and stress this has caused. It is not helping my medical issues at all. Help me please….
Debbie,
We would need to see a copy of the denial letter and the policy. If MetLife had paid you a full benefit while you were working then there could be grounds for a right to collect an overpayment. Please feel free to contact our office to discuss in greater detail.
Hello – I also am on Metlife LTD through my Employer’ Group Policy at E.W. Scripps. I have Fibromyalgia but most prominently is my Multiple Sclerosis.
For 14 years I have been on a slow decline and recently that has changed. I am on SSD and have no issue with pay. Sure it would be great to have more money but that is not my issue.
It is that Metlife now has outsourced the Claims Department out of the USA. You call the number and get no one. A recording asks you to hold or call back .. SO you hold .. It then loops back telling you no one is there to answer the call, leave a message .. No one ever calls.
All I wanted to update my information, yes, to do what was the correct thing. Now all I get is Employee information from Scripps (???) which I never hear from except when they switched from Aetna (original Health Plan) to Metlife.
I had to fill out my Income Verification and Health Updates for a few years but knowing it was a Progressive Disease and chatting with my Agent he agreed no more updates. Until they outsourced and I contacted this new group that did not understand a thing.
I am in the process of getting a full update from a Neurological Consortium of Doctors as my situation seems worse. However trying to reach someone is pitiful and they want to have a Doctor’s review after I explained I will be seeing these Doctor’s in early October 2015.
Now I cannot get through at all and of course Corporate makes it just as difficult.
Adrian,
Is your monthly benefit still being paid? Please feel free to contact our office to discuss the current status of your claim.
I have had a hard time getting anywhere with MetLife on my maternity leave claim. They delayed my approval to the point where I went one month without pay and stated I was only approved for less than 6 weeks from my delivery date. I worked up until my delivery date and had what they call a dry labor and delivery and had to be induced 3 weeks early due to dangerously low amniotic fluid. The 5 day review process has taken over 10 days each time my doctor or I send a fax. I have worked for my company for over 10 years and feel like no one cares especially MetLife. I need help getting them to review my information within a reasonable timeframe and need them to understand my doctor will not release me to return to work at minimum 8 weeks due to the nature of my delivery. I feel like my hands are tied and they are being anything but helpful. Can they trump that the doctor says is safe for me to be released to return to work? Work won’t let me return without a doctors note? I am lost.
Kellu,
Please feel free to contact our office to discuss your claim in greater detail.
My claim was delayed without just cause. I had two case managers working on my existing case. One day after my claim was submitted and without any medical information authorization form submitted to Metlife by me, a representative attempted to get information from my doctor. My doctor refused and asked that a release form be faxed. It was not done. My claim went without approval until 1 month later and Metlife claims they reached out to my doctor and information was not sent. This is an outright lie since I watched my doctor face over the Notes. Still the claim went unapproved and poorly handled. The claim was recently extended and recommended for an IME REVIEW. In the meantime, I am without pay because of the handling of the claim. Do I have any recourse?
AH,
Please feel free to contact our office to discuss your case. Ultimately, it is your duty to provide “proof of disability” as such it is not MetLife’s legal obligation to procure your medical records. If there are outstanding records needed by MetLife I would strongly recommend you obtain the records and submit.
Hello:
I am a 30 year old female with chronic pain in my lower lumbar that is a result of severe disk degeneration, arthritis throughout the spine, a bone missing in the spine, torn discs, herniated discs, buldged disks, pinched nerves and several other issues. Due to the low success rate of having surgery to correct the compounding issues, the neurosurgeon enrolled me in a rehabilitation program that not only looks at the physical aspect to chronic pain, but mental as well. Insurance fully covers and supports the rehabilitation program, but I am having issues with Metlife seeing this program as a reason for disability. Due to my company’s plan of only paying 65% of pay while on disability, I decided to work 2 days a week with strong work restrictions and limitations.
It has been two months; my doctors (yes multiple) and myself have submitted everything that was requested and then some, but Metlife keeps denying me for reasons such as “everyone has back pain” and “why can I go to the program but not to work” (one of those coming from the manger of the Case Manager’s). – Not only has MetLife continually been insensitive, they conveniently “misplace” paperwork and will admit to misplacing paperwork that delays the process for an updated review. I have a log of everyone I’ve talked to, when, times and what was said on THEIR recorded line.
Is there anything I can do? I’m desperate!
Tiffany,
If MetLife has formally denied your claim you will have a right to administrative appeal under the policy. Please feel free to contact our office to discuss.
How long does it take after your court hearing date to hear something? I read that it usually takes 90 days but it has been longer, it has been 4 months now. Is this usually about the time frame that it takes to hear something. I contacted my attorney and they said they are waiting on the judge to make a decision on my case. They told me that my file is there and they are not waiting on anything else. Just on the judge to make a decision on my case….
Dee,
You will need to consult with the attorney that handled your case for a better idea as to what you can expect.
My employer has STD and LTD via MetLife. I have been approved for LTD benefits. I received one payment but then they stopped. I called to find out why I did not receive the next month’s benefit payment and was told my account was placed on hold. Agent stated that I should have received a letter stating why. I did not receive a letter. Since Social Security paid me, MetLife has over paid me. Okay I can understand that. Here is where the fun begins…
Will you email or mail me a copy of the letter that I did not receive?…’yes I will do that’
How much was I overpaid?…’I cannot calculate that right now, but you can do the math’
Can I speak with your supervisor?…’I am the supervisor’
‘Can I call you back I have to run to a meeting?’…Sure I understand
‘I have bad news, my meeting is going to be all day. Can I call you first think in the morning?’…Okay
Well folks…it has been 6 business days and have not heard from or received a letter from MetLife.
I could tell you several additional horror stories but the all seem to be covered already. I am currently researching how I can get help with my problem. Right now for me the biggest problem is not being contacted. Yes I need the LTD payment but I cannot even get someone to be honest with me from MetLife.
Liza,
The typical pass the buck and play dumb approach. Please feel to contact our office to discuss your claim in detail.
I receive LTD from Metlife and just got a letter stating that my Basic Life Continued Protection (Life Insurance) has been terminated because they did not receive sufficient medical information detailing my disability. What does this mean, does this affect my LTD payments? I did call them and they said this did not have any affect on my LTD only on the life insurance.
Rebecca,
It means your claim for waiver of premium under your Life Insurance Policy has been terminated. Most Life Insurance policies will waive premium payments if you have been deemed unable to perform any occupation. A denial of Waiver of Premium does not in and of itself affect your disability claim, but it is something to be concerned about as it may be a precursor to a disability denial if your claim is near a change in definition to the any occupation standard of disability.
I am currently receiving LTD from Metlife after working for Verizon. I will only have benefits for 24 months since my issues are due to mental health. There are 2 exceptions to this 24 month rule, one is pscitzofrenia and the other is dementia. My current treatment is unleashing more symptoms that I want aware of. I have one more year before I complete my 24 month limit and I am currently being screened for Parkinson disease which is a form of alzheimers, I believe. This is because some of my symptoms for my current reasons for being on LTD are the same for Parkinson, especially the severe memory loss that I’ve been experiencing for years. Also, my mental health issues some of which include obsession and mood type disorders now may add a diagnosis of pscitzofrenia even if a mild form. My question: is too late to add these diagnoses to my case and if it’s not too late then would they be given the same amount of time payable as stated in my LTD paperwork that they would be paid until age 65?
Linda,
You need to make MetLife aware of all updated diagnoses so they can determine eligibility for benefits beyond the 24 month period. Please note however, that even if MetLife determines your claim is not limited to the 24 month period there is no guarantee it will be paid until age 65. Please feel free to contact our office to discuss your claim further.
I’m 48 yrs old and had total knee replacement surgery on Oct 20th. As a result of the nerve block, my femural nerve is now dead. I can’t lift my foot or move my leg at all. I can’t walk at all w/o a walker, and even at that, it’s a short distance as I drag my foot and leg behind me. I can’t go up and down steps, and I can’t sit for longer than 20 minutes at a time. My problem is this….I work 1 hour and 20 minutes from home, there’s no handicapped parking at my building, and I work on the 17th floor. I have a desk job, so I can perform my job functions, the problem is, I can’t get there. I need to stand every 20-25 minutes, which is impossibly w/ the long trip to and from work. There’s no way I can park at a parking garage 2 city blocks away and drag myself thru the city. And God forbid I get up to the 17th floor and there’s a fire. I can’t go down 17 flights of stairs down the fire escape. MetLife is ready to deny my claim and force me back to work. Where do I go from here?
Amy, one large concern, which I am sure MetLife is eluding to, is a body of case law that indicates getting to work is not a material duty of work. Please feel free to contact our office to discuss your claim in greater detail.
I have an active duty military pension for twenty years of service plus a VA disability pension of 100%.
Will MetLife consider one or both of these military benefits as “offsets” and deduct them from a pending award
for a group LTD policy?
Bob, it will depend on the language in your policy as is relates to Other Income. I recommend you obtain a copy of your policy if you do not already have one to verify.
I suffer from Arnold Chiari Malformation, and I was an employee of Verizon when I had a posterior fossa decompression. ACM has more than 50 symptoms associated with it, as well as an occipital and spinal headache due to the disabled csf to the brain. Metlife covered me ONCE! And that was after and appeal for the time I missed work to have the back of my neck, spine, and skull operated on. I received payment in3 different checks 6 months AFTER the claim. Due to the condition, the surgery only SLOWS the progression of symptoms, and now they are finding that the operation may make the condition worse, adding the complications of a searyngomyelia (a cyst of spinal fluid that collects in the spinal column, getting larger until CRACK), as well as increased pain. I have missed work due to injuries on the job, an example would be 1 month after surgery, when I stand up and bash the base of my skull on the corner of an open cabinet that someone obviously didn’t know how to close, but the last on the job injury was the worst. Verizon built a concept store, and this store was like a techies dream, it also came equipped with the hooked metal rods that are used to pull down the steel mesh curtains over the windows at closing and raise when they open for business. I had problems with the task, due to ACM, and a male coworker decided to show me how to make it easier, while observing him, a customer pulled up, and we were not yet closed. My job is to take care of customers first. My peripheral vision caught a flash, and then nothing but pain throughout my head, before I hit the ground, the same coworker caught me, but I couldn’t focus, I had bad coordination, and the spinal headache was the icing on the cake, it goes well with the tinnitus. We both reported the incident to the manager on duty and he did NOTHING! Needless to say, I didn’t go to the hospital because my manager didn’t KNOW what to do. When I was driven (because I couldn’t drive, walking was becoming a problem as well) the different manager on duty recorded an “incident report” from both sides, and I went directly to the emergency room before the paperwork was finished, because I was in agony. I had to stay in the hospital for a “30 hour observation” which was longer, but I was deemed a fall risk, and had some neurological drug pumped into my system by my neurosurgeon. After I was released the continued problems with the repercussions of the “incident” made me file with Metlife for the hundredth time! And I was denied! My appeals denied! Verizon’s human resources started requesting weekly reports, referred to as “Work Place Arrangements” that cost $25 per report. I was told that my doctor office had up to 2 weeks to fill out and submit any documentation BY LAW! I was released due to what they call “job abandonment” although I spoke with hr the prior week. Is this fair? I’m owed for each time Metlife denied my claims, as well as wrongful termination.
Vanessa, please feel free to contact our office to discuss your MetLife claims to determine what we may be able to do to assist you.
I have worked for Oxford Life Ins. for going on 7 months and was always told I was doing a great job by the Attorneys during our appeal meetings. But on December 29th of 2015, I received a rather abrasive notice fro my manager stating my work product was poor, and that I didn’t seem to be clear on some instructions I was given. He had cc’d several other people and I became the laughing stock of the office, making my working environment hostile and I began to have episodes at work and in my home life of memory lapses and black outs that would last up to 5 minutes. (Not related to drugs or alcohol). I have tried to submit a workers comp claim, but that was denied, Now they are doing their best going throught their carrier MetLife to deny my wages and medical testing.I am a single mother and my son is on expensve medications. The doctor has ordered more testing, but I have used all my savings and cannot find a neurologist or someone to perform a CT scan that is willing to wait for payment. I have $53.00 left in the bank and don’t even know how I am going to provide food for my 2 children, much less get any testing done. I haven’t had a paycheck in 6 weeks. Metlife told me they do not have forms the MDs need to fill out but gave me 5 questions that the MD’s needed to answer. The first MD that wrote my DBL letter told me he had informed me I needed to go to a neurologist, but he never said that to me (that I could remember), however, once I went to my PCPs office today they looked at their copy of this psychiatrists notes are there is no order or any indication he ever informed I should go to a neurologist. Both He and my PCP will write disability notes, but will not fill out the 5 questions I need answered, which are pretty basic questions.So, I have no income, no medical insurance and no way to get the testing done. I can provide nothing for my children and short of filing a complaint with the Arizona Medical Board against my psychiatrist, I am completely depressed. My Childrens Dad does not feel that he has to pay any child support so that is a lost cause. I don’t know what to do at this point.
Diane, please feel free to contact our office to discuss. Has MetLife sent you a formal denial letter?
I have filed my claim since February first 2016. I have provided every piece of information they have asked for my doctors have written documents attesting to my total and permanent disability. I have given a full/release of my records. Every week they say that are still waiting for more paperwork and the claim is pending. My case worker Ashley Ramer privately said that MetLife drags it out like that because a lot of claimants become tired and give up. But I will fight them.
Ben, MetLife is fast approaching their deadline to provide a determination on your claim. Please feel free to contact our office to discuss your pending application in greater detail.
Worse experience ever!! Constant harassment to my husband who was bed bound 20 hours a day!! Told him he needed to find a job and lie to employer about his disability. Eventually Met Life agreed to pay claim for long term disability but then denied disability life insurance.
Hello, I’m 41 and disabled and currently collecting ssdi benifits and Metlife LTD benefits for myself and my children since 2009 and been approved for LTD benefits till 2039 from metlife, with over 20 yrs still left on my approval. Is there a possible to get them to do a lump sum buyout with seeing as my children get older and ssdi takes them off at 18 yrs old. Metlife will have to pay more seeing my policy has it that I’m to make $5,000 a month till 2039 and if I can sell it to them what happens to my $150,000 life insurance I have on that same policy, thank you for time!
HK, MetLife has very recently begun negotiating buyouts of disability policies. Typically, when a LTD policy is bought out the life insurance policy remains in force with waiver of premium so long as you remain disabled under the terms and conditions of that policy. Please feel free to contact our office to discuss how we may be able to assist you.
I am dentist.I also work for army Reserves.If i am pulled for active duty and get disabled,Can i still get Disablity benefits from my insurance company (guardian).
anonymous, it depends on the language in your policy and if it has an exclusion for disabilities resulting from active duty.
I have been employed for 20+ years at Goodyear w/Met-Life as the LTD carrier. In Aug 2014 I went down with my knees unable to support my weight-degenerative failure + Osgood Schlatters disease (soft tibia bone). Was advised by several Doctors to try knee replacement w/high risk of failure due to weight and condition. I replaced one knee 08-2014 and the second 01-2015 and worked through re-hab. I tried to return to work on 07-2015 hoping pain would subside and knees would be normal. Instead, pain worsened and I had to go into pain management to include use of Morphine to quell pain. Multiple times Met-Life denied the claim or failed to approve the claim stating my doctors were not sending information. I checked with Doctors and they had been all along. To include one day when I stood there and watched them fax info off and receive an acknowledgement of receipt. Met-Life lied to my face saying they still hadn’t received it until I said I had watched it. Every month or every other month I have received a letter (since going back out on LTD in Nov 2015) stating the claim was going to be denied for different reasons. The latest letter says that as of 06-25-2016 Met-Life will no longer approve LTD benefits because I should be able to work now. Despite my doctors having provided them with the Goodyear standard work tolerance report indicating I should not work. I can’t walk without assistance, wheel chair etc, I can hardly stand and am currently on morphine to the extent I cannot work or focus long on much of anything without napping. I believe that Met-life systemically engages in these tactics knowing that I do not have money for these constant doctors visits and it is more than just an inconvenience it’s actually painful to go out constantly. I need help…
Doyle, please contact our office with a copy of your denial letter so we can discuss your rights and options available in appealing the denial. MetLife only provides one level of administrative appeal so it is imperative that your appeal be as strong as possible.
I was put on std from my employer then it turned into ltd 2 level spine fusion with a morphine pump in my stomach feeding my spine due to pain. I got ssd of 1800 and that amount subtracted from ltd payment which leaves me 450 a month from metlife. They have asked for 5 different time a functional cap test. Dr pretty much said no work no lifting no bending and so on. Jan. Metlife called and told me deffinition of disability changes. How can they change definitions of words, is that legal? Can I change definitions also? If they can I should be able to. If my doctor said I can’t work can Metlife say oh I can work? They said they take into consideration my age what I can do and it must be 80% of my gross pay when I was working. I have been a welder only which no way I can do now. Whats going to happen in nov 2016 80% comes out to 16.50$ an hour. Will they try to cancel me and my crummy 450 a month?
Robert, with respect to your question as to change in definition of disability- yes, that is legal. Your policy has language that reads after a certain period of time (usually 24 months) disability will be defined to mean the inability to perform any occupation and in your case it looks like it would have to pay you 80% of your pre-disability earnings. MetLife can always have your claim reviewed by a doctor and if that doctor disagrees with your doctor’s opinion that could be enough for MetLife to deny your claim prompting need for an appeal. Have you performed a functional capacity evaluation? Please feel free to contact our office to discuss your claim. There may even be a chance to try to secure a lump sum buyout of the policy from MetLife.
After winning Social Security Disability and owed back pay, is there recourse I can take to get the residual amount owed from a previous Metlife LTD Denial? Would Metlife also to owe me the difference between what they should have payed me, minus what I’m getting from SSD? If it’s worth it, should i get an attorney to go after Metlife?
Verizon claims it’s benefit package is/was superior partly due to the fact that the premiums for employee short term disability are paid for by company. Every year we heard variations of the same underlying message “Short term disability coverage is an employee benefit in place to help you when youre sick and unable to work due to illness. And it helps you lower stress from illness because you are paid, and guaranteed your job when you return to work.”
My position – Metlife disability is not a benefit, and it should never be called a benefit. Reasons: If you need surgery, you’re covered. But if you begin having severe panic attacks, your Dr says you’re burning out, take these pills, talk to counselor, regroup, then Metlife has the power to ruin your career. This happened to me. I reported to a VP, when he learned my claim was denied, I was treated as though I took advantage of system…. Tried to pull a fast one. This made my medical situation worse. I lost job.
Metlife confirmed they cover panic disorders, but the reality of getting coverage is kept from you. I have documented examples, including this…. I used Verizon’s mental health counselor to fill out Metlife forms, then 4 weeks later I get a letter from Metlife saying I need psychologist, not counselor – denied. Try again or appeal.
Metlife also handles Verizon’s ADA form approval by validating medical forms submitted with ADA workplace accommodation form. Yes I submitted an ADA form. Then had panic attacks because ADA process unbearably demanding and one-sided. Well when I initiated my panic attacks claim, Metlife shared this information with the people managing my ADA workplace accommodation form. Then, the ADA form denied based on medical I submitted for panic attacks.
There’s a hippa violation, and defamation too, which I’ll explain if it comes to that.
I was with Verizon for 15 years.
Im 2015, Verizon began stopping departments from allowing employees to work from home. As a result, more Short term claims submitted to Metlife, a publicly traded company. Verizon policy change -> incresed number of metlife claim submissions -> Metlife already has a “number” of claims they can approve before going red. Metlife is not a benefit.
Many Verizon employees told me that they’ve repeatedly let upper mgnt know the issue with Metlife, and that it isn’t a benefit to all. Employees have lost homes, etc. Because they thought Metlife was there to help.
I lost job too. I have a lot of documentation.
Aja, when you say previous LTD denial, what exactly do you mean- for a denial of a previous claim not related to a current claim? To best determine if we can assist you please feel free to contact our office to discuss your claim.
M A Miller, please feel free to contact our office with a copy of your denial letters(s) to discuss what we may be able to do to assist you at this point.
I am out on Std claim thru verizon my employer and Metlife the insurance co they use. My dr released me back to work in beginning of January so Metlife had me go to one of their dr who said no I can’t go back yet give it three months. I go to another Metlife dr who releases me and now verizon says they need more questions answered by the dr and will not let me back . It’s been two weeks (Monday) and I get the run around when calling MetLife saying they received a fax from the dr but wasn’t what verizon was waiting for. I call everyday and no changes. My Std runs out next month and I don’t know what to do to get back to work. Released but I’m not working and getting no answers.
Tammy, it is not typical that MetLife would send you to one of their doctors to clear you for work. Please feel free to contact our office to discuss your situation in greater detail.
My husband has been on LTD for 10 years due to complications from a stem-cell transplant. He suffers from a condition known as GVHD (Graft Versus Host Disease). During this time the company he worked for was sold and his position was eliminated, leaving him unemployed (thank goodness for the disability). He is on immunosuppressants, suffers from severe muscle cramps throughout his whole body, fatigues and stresses very easily, and has diminished cognitive skills and “chemo brain” where he is very scattered and forgetful. If he over does it for a day, he can barely move the following day or two.
Recently, MetLife sent a new questionnaire to his doctor and according to the questionnaire he is now 90% able to return to work. His previous job before disability was as a corporate trainer, standing in front of classes talking all day. When he does a lot of talking, his jaw clamps shut and he’s unable to open his mouth. When he walks around a lot, his legs and feet cramp. If he’s even doing something around the house (like holding a screw driver) his hands cramp and stay in the position of holding a screw driver. I could go on and on. He does exercise a few days a week to try and stay healthy and help ward off the depression, but he can by no means keep up with his peers or do nearly what he was able to do before the transplant.
My question is, since he has no job to go back to and since it would be impossible to go back to training, can MetLife just terminate his benefits cold-turkey and make him do anything he can get regardless of pay? According to them and apparently the doctor’s questionnaire he can do light sedentary work. But seeing my husband every day, I know he can not put in a full days work every day and light sedentary work will not pay him close to 80% of what his previous salary was.
Thanks for your help.
AB, if your husband has been on claim for 10 years under what I presume to be an employer provided MetLife disability policy he would already be well into the “any occupation” standard of disability. Under this standard MetLife would not have to look at his ability to perform his former occupation, rather his ability to perform the duties of an occupation he would be suited for based on his training, education, experience, and as you noted that would pay 80% of indexed pre-disability earnings. As such, it is not likely that MetLife would deny his claim, but that is not to say it couldn’t happen. MetLife recently began offering and negotiating lump sum buyouts on disability policies. If you and your husband do have concerns about it his claim it might be something worth considering. Please feel free to contact our office to discuss his claim further.
My husband was provided STD through MetLife for Psoriatic Arthritis which has caused him to have a shoulder transplant, yes transplant, he is only number 8 in the country. He has also had two back surgeries which caused a permanent drop foot due to severe radiculopathy. He wears a brace. He will also have bilateral hip surgeries in August 2016 and January 2017. He is up for review for “permanent” disability. They are currently reviewing this. As an ICU nurse, I know medical jargon very well so I have been very active in this campaign . I have heard nothing positive about Met Life but our rep has been very kind. We have the MRI, PT, EMG and all tests that state he has permanent radiculopathy and nerve impingement because the transplant, and hip surgeries only qualifiy him for 24 months. What are his chances to receive permanent? He was also diagnosed with rhabdomylisis which gave permanent myopathy all at the age of 36. He was a hard worker and loved hiking and anything outdoors but this disease has taken his body but not his soul. Thank You.
Jill, hopefully your husband will never need an attorney. In the event you have an issue or have any questions please feel free to contact our office.
Hi, I am with metlife on ltd. They have all kinds of loopholes to subtract your benifit dollars. Why is it companys sell ltd and never give you a benifit package. Could it be if we knew all the crap they put into the policy we might not get it? My claim has been as expected so far but they warnd me of the any occupation definition is comming in nov. If people knew that mental dis. Only last 2 years and just about all incomes you get from other sorces is subtracted from metlife check. I think there should be a law for all disability companies give booklets on all the loopholes length of benifits. All the information on your policy we pay for just like you medical insurance,dental, I even got one for pet insurance but no disability. 90% of these questions could be answered with a explaination of benifits booklet. Why is it everyone finds stuff out when you get cancelled, why don’t these crooks give out all the information when payments start to them?
I am new to this whole disability thing I am only 23 and my back isminjusred to the oint my doctor put me out of work for a few weeks I am so scared that my claim will be denied and I will be fired….
I was recently denied LTD insurance from Metlife. They claim the reasons for denial are based on a history of: Chronic Thoracic pain, Anxiety, Sleep apnea. The only continuing aspects of that are: I have been on Fluoxetine (20mg/daily) for 11 years with no troubles or missed work as a result, and a CPAP that I use nightly while sleeping to prevent snoring (that I’ve used for about 3 years now). The back pain was an old problem from a pulled muscle that cleared up a few years back.
How can I get a better understanding of what legal basis they have to deny insurance on the basis of these things?! This seems absurd to me that an insurance company could arbitrarily decline to insure based on their “reasons”.
I have been diagnosed with pulmonary hypertension, asthma, edema, and fatigue. MetLife has been fighting me since June 3rd this year. I am being forced to retire because of my health and had taken 8 weeks off while having medical tests done and they refuse to pay me for that time!
Dave, we would need to see a copy of the denial letter in order to properly advise you. That being said, it appears they are essentially arguing that you have been able to work with the problem for 11 years (or however long), so “what changed.” Please feel free to contact our office to discuss further.
Vicki, please contact our office to discuss what we may be able to do to assist you in securing your benefits.
I have been receiving SSDI & Metlife LTD payments since April 2006. Every year Metlife sends me a form for me to fill out as well as a new physicians statement. I have always been very timely and compliant with their paperwork. Today I received a phone message from a new case manager at Metlife stating he wanted to make me aware of some provisions and ask me some questions. I have the full support of my doctor yet I am having high anxiety about what these provisions are all about. My question is “Can Metlife stop paying my LTD?” & if so, “Do I have any legal recourse?”. I immediately tried to return the call but received a voicemail.
MetLife had pi follow me and I have chronic pain anxiety and meneirs. They said because I took the trash out and went to my moms with my sons I am able to drive which is not true. I was a vp and have permanent disabilities and k owing they hired a pi to follow me adds to my anxiety I have from the amount of pain s vertigo that I already have. Some nurse named Sara reviewed my claim and said bec I have anxiety from pain my claim is denied. I have 5 doctors proving I cannot work as I am dizzy and cannot sit or stand on a regular basis bec of my conditions. I asked them what their process was to return to work and never received information. Also, they have stopped my checks which caused me undesirable pain an distress because of my definition of disability which is try.
Robert, MetLife, or any insurance carrier for that matter, can terminate a claim for benefits if it determines that you no longer meet the definition of disability. Your lengthy claim history would allude to a strong case, but there is unfortunately no guarantee that MetLife will continue to honor its end of the bargain. If they were to deny your claim you would be entitled to administrative remedies and then civil action. If you have questions or concerns, please feel free to contact our office to discuss your claim in greater detail.
Ginger, have you received your formal denial letter? Please contact our office to discuss your rights to appealing the denial of benefits.
Per my husband’s primary care physician, he is suffering severe depression ns, bi-polar, and recently suffered other conditions leading to a colonoscopy. Because he has tried 5 different medications, referred him to a specialist. The appointment is now 1 week away,it being the end of September. He has not worked per primary since May,receiving 2 Short Term Disabiity checks. They called today stating that they were not extending claimed from August 8th. The man is not capable of making monetary decisions, sleeps excessively and I walk on eggshells. not knowing “which” person I am going to wake up or go home to. Metlife has hastily made this denial decision unaware that the primary does not know how to treat his medical condition, refereed him to a specialist, who will takeover treatment and release he m for work when he is stable. We have waited several months to get into this specialist, gone through our savings, starting to dip into 401k, etc. With 1 week to go, I don’t think it is fair that Metlife has the right to deny the claim when he is following all suggestions and taking the medication that his doctor diligently until his specialist appointment. An addition to the mental stability, he has now told me he has some male issues and at 45, since cancer runs in his family, I have scheduled an emergency colonoscopy. Metlife’s case worker is never available to speak to and they just send doctors’ notes to their clinician whom you never speak to and cannot have the opportunity to explain the severity of his conditions. A man does not purchase a home at 25 and at 45 still live in the same place, nor does he hold a job with the same company for over 12 years being stable to going to someone that has emotional roller coasters, anger outbursts, and not be able to make sound decisions. He took me in at 11:00 when I left my ex-husband, completely as a platonic friend for two years and not ask for a dime. This is not the man I married, has admitted he has a problem, and is basically being punished for getting the help he needs. Funny how they paid two checks yet now a week away are saying they are denying as of August 5, and it is September 22, specialist appt on September 28. I wish a MetLife rep would live in my house for a day.
I am about to file a LTD claim due to several medical conditions. I was told I had 10 years to live in 1996. Well I have come to the point that I need to stop working because I can hardly walk and some days can hardly move at all. If I get my LTD through Met Life and then get approved on my SSD 5 months later do I still have to pay met life back even thought I could not file for SSD for the 5 months by SS regulations? Do I only have to pay back what Met life pays me AFTER I have waited the required 5 months before filing SSD?
GOODANGEL, please contact our office to discuss your husband’s claim. If MetLife was issuing a formal denial of benefits they should have sent a denial letter stating their position for the denial as of August 5.
Steve, any overpayment repayment obligation would only contemplate the months that the SSA is actually issuing a benefit, so the initial waiting period would not be used against you by MetLife.
Hello, through my employer I have a Long Term Disability insurance via Metlife and I’m concerned about the language used in the policy.
The policy reads “After expiration of that 12 month period, disabled means that, because of a sickness or injury, you cannot perform the important duties of any other gainful occupation for which you are reasonably fit by your education, training or experience.”
My concern is that I’m currently a highly skilled employee, in Computer Science research with a PhD, with a reasonable compensation. If I suffer a brain injury, that incapacitates me to perform my current job or similar scientific research, could they deny a claim on the basis that I can perform “other gainful occupation” that is much less skilled than my education level?
When inquiring about this, Metlife could not resolve the question without me actually filing a claim. My employer HR people are not aware of any instance in which a similar denial has happened.
Overall, I would like to know this ahead of time so that if indeed this policy is ‘hollow’ I can get another policy to cover the risk.
Ricardo, unfortunately, we would not be able to predict what could potentially happen. Ultimately, the answer to your question is yes as it is possible. A 12 month own occupation period is very low (most policies cover for at least 24 months) so the policy does not afford a lot of protection. I would recommend you contact an insurance agent and discuss your options in securing a Private Individual disability insurance (IDI) policy that will allow you to choose what language/provisions you would like. Please note that a IDI policy will supplement an ERISA employer provided policy.
March 2013 I was diagnosed with Multiple Myeloma cancer and had a surgical procedure to insert a chemo port. June 2014 while preparing for a stem cell transplant, doctors discovered a clot in my heart that required open-heart surgery before the transplant, which was delayed until October 2014. I went on STD which turned into LTD. Consequently, I lost my job as CEO of a community service agency.
Metlife administers my plan and has stopped my benefits before without warning despite the fact they were supposed to contact my son (they never did) because I was neither mentally nor physically able to process all of the tons of information that they continuously requested.
My cancer is in remission but the type of cancer causes severe bone pain. In January 2015 I was diagnosed with having Cognitive Impairment no doubt caused by the strong chemo. I’ve also been diagnosed with fibromyalgia, Osteopenia, major depression and extreme anxiety. I see a therapist, an oncologist, a rheumatologist and my general practitioner.
July 2016 Metlife terminated my disability benefits stating that I no longer met the definition of disabled and That I was capable of ” doing my own job.” I appealed the decision in July and just today October 31, 2016, received notice that the appeal was denied based on lack of supportive documentation they said they didn’t have and the opins from third-party reviewers. Further, states as of July 2016, I was able to return to the job as CEO or obtain another job making 80% of my salary, which was $97K annually.
The information included in the denial letter are incorrect:
1. It states that I only saw the oncologist once, when in fact I moved to a different city and have seen him twice, plus had test done. When Metlife stopped my benefits, I could no longer afford health insurance from the Exchange, which was $496.96 a month. I only receive $1,148 a month from SSDI.
2. It did not include any information from the rheumatologist. Just because the cancer itself is in remission does not mean there are no residual medical problems to my bones, that I did not have before the cancer/treatment. MM is a bone and blood cancer.
3. It states there is no cognitive deficit. I have a full written medical evaluation that clearly and explicitly states a diagnosis of cognitive impairment, memory deficits and anxiety; ” We have found insufficient evidence of any cognitive impairment or mental health issues that would prevent you from earning 80% of your ore disability earnings.” Metlife’s vocational and another consultant determined that I was miraculously healed. Neither Metlife nor any other professional performed a functional re-evaluation, mental health status examination or occupational assessment.
4. It stated that I don’t have any mental health issues to prevent me from doing “my own work” and that my therapist reported that I have reported no issues anxiety or stress or depression. This is just an outright falsehood.
The letter states that I have exhausted all administrative remedies and no further appeals will be considered.
Robin, as MetLife only provides one level of administrative appeal, your only available option is to pursue legal remedies under ERISA. Please feel free to contact our office to discuss how we can assist you.
I unfortunately have Metlife through my employer synchrony financial. I have been receiving short term disability sporadically through the year. They have not paid me in over a month despite jumping through all of there hoops. I am losing my car, and have bills that are so far behind because they continue to mess with me despite having my medical information. I need help.
Eileen, please feel free to contact our office to discuss your current claim.
Hi my husband was covered by Metlife’s Life Waiver Unit due to a disability. The policy covered him through age 65. We tried to obtain their ‘conversion packet’ in order to continue coverage post age 65 but they will not forward the information. I’ve tried to get it through both them and Ratheon, my husband’s former place of employment. I’ve been told on 5 separate occasions that it was sent, but five times? Any suggestions? I was wondering if their were any others in this predicament and if there are any class action lawsuits out there?
Elizabeth, unfortunately I would not know what to suggest with the exception of requesting they email the documents to you so there is no issue regarding the mail.
I received all my short term disability and when it came time for long term disability I was denied by metlife although I was approved disabled by Social Security this was in 2015. I live in Texas, and suffer from severe rheumatoid arthritis. At the time I was so mentally unstable I never even filed appeal. Is it too late?
T.S., from the perspective of a strict 180 day deadline under ERISA to file an appeal, yes. That being said, it would not hurt to try to file an appeal at this time. If MetLife were to consider the appeal and deny the claim you could still have legal rights to pursue.
I have been on Metlife LTD since November of 2015. They approved me for major depression which incorrectly limits my coverage to 24 months since my depression is a result of my inability to do the work I truly love due to my physical conditions. Does my 180 days to appeal their decision come from the time they tell me I will receive the benefit for only 24 months or from the time they actually cut me off in November of 2017? Thanks
D.D., that can depend on the information they have sent you. Sometime they require an appeal to occur 180 days from notice that your claim is limited to 24 months. Please contact our office to discuss your situation further. If they are terminating your benefits come November 2017, it would be in your best interest to fight them as soon as possible as to physical vs. mental disability.
I was off for a severe case of pancreatitis. The last month of benefits were turned down because they say the doctor did not substantiate my claim. I know this isn’t true because I have two doctors sending the info in and saw what they sent. Met Life is a joke. Now what do I do?
Joseph, you have to undergo the administrative appeal process to try to get the last month of benefit paid. Have you already filed the appeal?
I have been on Ltd with MetLife for 5 years through my companys plan for verious spine issues and fybromylagia, they required me to apply for SSD which was denied due to only being 33 years old. My question is since I’ve been denied SSD will MetLife cancel my befits even though my doctor says I could only work 4 hours a day 5 days a week? My plan states that if I can not make a return to prior job as a mechanic wich I cannot according to doctor and SSD judge or make 60 percent of my previous earnings at any job, wich I could not with out experience or other skills and I can only work part time decided by SSD judge and doctor and also MetLife VOC rehab department. The plan states that it will cover me until retirement, but can they cancel now that I’ve lost my SSD case?
Anthony, the denial of the SSDI will not in and of itself result in a denial of your MetLife claim. However, MetLife could use information from the SSDI case as part of its own review to determine eligibility for ongoing benefits. Unfortunately, there is no such thing as a guaranteed disability benefit and it can be susceptible to review for any reason. MetLife does offer lump sum buyouts now so that may be another option to explore. Please feel free to contact our office to discuss your claim further.
I have a pending claim currently with Metlife ltd and as stated in written paper work a deposit was supposed to be made on the 8th direct deposit on the 14th and have a letter stating that this has been done. Meanwhile it’s now the 22 cnd and I have not received anything. Creditors are not paid on time as a result now and my 791 credit score is being taken down slowly.
Justify why my anger should not be growing by the day. Eventually there has to be a snap point. Between a job loss a failed workers comp system and an injury on the job with the Salvation Army who offers no cobra when I was at the point benefit wise able to meet deductables. A company who is suppose to help people but not there own now causing a medical bill rapeing. Additionally An exhausted savings, medical turmoil, disability games I suppose, my life might as well been completely hardshiped. None the less in 10 months has become a nightmare I never asked for. This was my last help for some financial restitution.
Better dead than alive it seems now lol. Least the credit hounds would move on. This saga has to end sooner or later thanks for the opportunity to speak my mind.
I have been on Metlife LTD for a few years. I am in a review right now and my doctor called me and said I would probably be denied. I also thought that is what the case manager told me. I panicked and got a job and only lasted 4 days and was let go cause I couldn’t do it and it was a lesser job than I used to do. The next thing I know I got a check from Metlife…I called them and they said I must have misunderstood and that I was still active. I am now wondering what the consequences of this will be that I went back to work without telling them? Will I be cut off immediately for going back to work or will I just be made to pay back the money I made for 4 days?
Mary, I don’t know if you have anything to worry about at this point. If anything they may just reduce for the 4 days of earnings received.
My employer provided a long term disability insurance policy for me. I was approved with Metlife, they contact me every three months by sending out forms to my doctor and calling me on the phone. How long will this go on?
Part II: I am being terminated from work if I do not return by the end of the month. According to my doctor, I am not fit to return even with accommodations. If I sign a separation agreement, will this affect my long term disability payments from the LTD carrier?
Dinah, no, you will still have all rights under your LTD plan as your rights under same were established at the time of your disability – when you were covered employee. It is not at all uncommon for employers to terminate employment.
I am purchasing both short-term and long-term disability insurance through MetLife via my employer. I’ve had fibromyalgia since 1995 and have had 2-3 different doctors who’ve treated me for it. None of the drugs for the disorder have worked for me — including those for fibroymyalgia, arthritis, depression. I also have panic attacks and take medication for that as well. There is a statement in our group policy that says that they may decline disability for a pre-existing condition. It’s only been in the past 1-2 years that it’s progressed and I’ve been missing more and more time off from work as a result. My question is this, I suppose: Before I subject myself to going through the process of getting my doctor to complete the disability forms, is it a good chance MetLife will deny my claim as a “pre-existing condition”? I’m 60-years-old and it’s getting more difficult daily to even do mundane tasks at home or at work. Also, if my doctor completes the form for disability and then I get denied, will I be in a mess with my employer? Because they’ll then say my doctor stated I’m unable to work. Oh boy, I don’t know what to do. Any suggestions would be helpful. Thank you.
JuJu, if you are not currently covered under any policy and MetLife does insure you under your employer’s plan then you would have a pre-existing condition for purposes of the plans. Most STD policies do not contain pre-existing limitations, but every long term disability plan would. Under most LTD plans you would have to be covered under the plan for at least 12 months before the pre-existing condition limitation would be waived. So, if you get the coverage chances are you will have to wait at least a year before you could safely make a claim under the policy. That being said, without knowing your exact policy language we would not be able to verify the timeframes accordingly.
I had a workers compensation claim and it settled in 2014 with me being on permanent restrictions of which my employer has followed for 3 years 8 months and 3 days then out of the blue Jan 19 2017 they claim they no longer can follow my restrictions. 1 week later they send me a letter saying basically I should never have been working and won’t let me come back to work as long as I have restrictions. I talked to the attorney that handled my case she said it’s an employment matter and also talked to another attorney that said the same thing and to file charges with the EEOC. My employer sent me papers for metlife short term disability I filled them out and sent them in and was denied they claim it’s a work comp matter. I am appealing it and still they claim it’s work comp and they want me to get a denial letter from work comp. I sent them papers from the attorney I saw that states u saw her for an employment issue. So how can I get a denial letter from work comp when I don’t have a work comp case? I don’t understand how I pay for sethink and I can’t use it. I’m also from Illinois if that makes a difference.
Krishauna, since you did have a worker’s compensation claim that was settled in 2014, I would suggest providing MetLife with paperwork to show the claim is over and that you have no pending worker’s compensation claim. I would also suggest you discuss your situation with a worker’s compensation attorney to cover all of your bases. If you have not already filed your appeal with MetLife please feel free to contact our office to discuss how we may be able to assist you.
My husband has been on Metlife DI for nine years. He will be 62 this year and has an opportunity to begin collecting a small pension from a previous employer (NOT the employer that provided the DI but one he worked for from 1974 to 1993). We would love to begin receiving it. There is no financial advantage to waiting to age 65; the dollar amount does not increase.
My question: Can Met use this as an offset and reduce his benefit? In that case we would actually be worse off because his Met benefit is only 50% taxable while the pension is fully taxable.
The booklet from Met addresses this but in such legalese that I can’t be sure. It refers to “the Employer” (capital E) as being the one who provided the DI and states that any retirement benefit from them would be an offset, but he doesn’t have anything from them, wasn’t there that long.
It would seem a separate, private pension is none of their business but they seem to think everything is their business. I am reluctant to call them because the offshore people are not easy to communicate with and I also don’t want to incur their scrutiny, especially after seeing all the comments on this site.
I would appreciate your thoughts. Thanks.
In 1995/6 laws were where you couldn’t sue Metlife on a State level. It had to be at a Federal level. My Att. at the time with their large law firm said he couldnt fight them. The Federal law on the books at that time was ” Unless you could prove the insurance company arbitrarily and capriciously “caused” this disabilty on you it was thrown out of Federal court! I loved my job and was forced into accepting Medicaid in order to pay for my numerous medical bills all these years. Thank God I at least was able to collect SSDI vs SSI. I’m 66 now and on my last road to travel. I wanted to Thank your law firm for helping those who are fighting Erisa policies and Metlife. I will go to my grave with sadness in my heart for having a “true disability”, loss of a profession I loved and living in poverty all these years.
Christine, pensions/retirement benefits from a previous employer (not related to the employer the policy is received from as you noted) are not an offset under the policy. If you would like to discuss the policy please feel free to contact our office. You can also make inquiry of MetLife as to the issue – I would recommend doing so in writing if you do.
Thank you for your kind words Trudy. I am sorry that you had such a horrible fight with MetLife. Unfortunately, things haven’t changed much in the area of ERISA since the 90s.
They are not right and if you don’t know your rights they can mess you up you can not trust them. Keep all your document and make sure you record everything you send them paper work keep up with your Doctors and report.
MetLife is sending a payout offer is it tax free? I have no idea what they’re offering.
Kim, with respect to tax inquiries you would need to speak to an accountant or other tax professional to determine the taxability of the settlement.
I was working for the school board of broward county fl for more then 20 years. I came disable for there and Metlife was paid my check but sudenly one of the representative or my case manager was tell me about allsup company to help with the social security aproved but really they didn’t nothing. I did what I have to do, send papers to social security and finally they aproved me but the social security didn’t say nothing to me about so I check my bank and suddenly I saw money on my account 16.000 thousand and Metlife write me then I have to paid then that was overpayment but what overpayment they stop my check before and social security didn’t let me know. Then I was aproved, now I paid to Metlife 4.000 thousand for no reason. I want Metlife to return that money back to me. How can I resolve this? Thanks.
Jose, MetLife has a right to seek repayment (and offset of monthly benefits) for any period of time that they paid you that overlaps with a time that SSDI issued a benefit.
My husband is out of work on FMLA for mental health reasons. Metlife paid him for the beginning of the claim. They then asked him to submit more paperwork to continue his claim after the initial 30 days. My husband submitted the paperwork, which stated that he had also had a hand injury while he was out during his current claim. Metlife told him that because he now had a hand injury he would need to submit a new claim with the documentation from that. Metlife then went on to deny his claim stating that he was never supposed to have opened up a new claim. When he called to speak with a supervisor and inform them that it was based on their own representative’s words that this new claim was opened, The supervisor stated that it was unfortunate but the employee was wrong and that was not the proper procedure. They then told my husband he needed to submit more paperwork so that they could reopen his claim. After my husband submitted the paperwork they denied the claim stating that he was not supposed to have opened the second claim and there is insufficient paperwork. Now my husband has not been paid his benefits since February despite him having 2 doctors that support him needing to be out on leave. Those doctors assert that they have faxed in all of the paperwork that Metlife has requested. Metlife is telling us it could take up to 90 days for them to review our appeal request. In the meantime, our bills are going unpaid, including rent, because I do not make sufficient income to support a household with children, by myself. Is there anything we can do?
Maria, so MetLife denied the mental health claim as well? That would not make sense unless they determined he was not disabled due to his mental health condition. If an appeal has been submitted as to the denial of benefits then there could be very little that could be done till the review is completed. Please clarify as to the denial of the mental health claim or feel free to contact our office to discuss in greater detail.
Hello, I have received 1 year std from Met Life and then met requirements for LTD for the last 9 years. My condition is neurological/auto immune and it is considered idiopathic,a slow progressing of worsening issues. Im going to be 54 in August and have 11 years left on the disability I received through work. Do you think Met Life would consider a buy out? I could definitely use the security of having the income now. Thank you.
Maria, your claim could very well be ripe for a lump sum buyout. Please feel free to contact our office to discuss your claim further to best assess what type of buyout offer you may reasonably expect.
I have been receiving LTD now for over 4 years with Meltlife threw Colgate Palmolive. I have Coronary Artery Disease. My short term Disability was a nightmare like most others but the company paid me no matter so was not too bad. The question I have is: I live in Tx and I am 53 and my policy goes till retirement age. We just bought a place in Florida and plan on moving next year. Does this affect my disability case if I change states? I usually only have to send in a Finance Statement each year but this year they wanted a normal updated medical review.
Scott, moving will have no impact on your claim. However, you will need to make sure to find a new doctor and continue treatment as MetLife will still require updated medical information.
I have been on LTD since Nov 2012. Metlife is the disability insurer. I was required to apply for SSDI and I was approved the first time in Spring 2013. I paid Metlife back the overpayment when I received my back pay from SSDI. I have always supplied the information requested by Metlife including all requests for medical, SSDI award information and filling out their forms. In the summer of 2016 SSDI did a review which I provided the letter to Metlife and when my SSDI review was approved I provided that information as well. In addition to the on-going reviews that Metlife does they also request a yearly review in December that they say is required by my employer that asks for financial information and other work related information.
In June of 2017 Metlife did their normal medical review which my doctor provided all the requested information. Now in July 2017 Metlife has requested that I get a printout from SSDI showing every payment I’ve received from SSDI from the time I was approved in 2012 until now. Every year I provide the $ amount of my SSDI so my question is, Can they ask for a printout of every payment from SSDI? Why would they request this now? I was told previously by my Metlife case mgr that COLA increases are not offset so I don’t understand why Metlife is requesting this now. It seems like they just want to ask for more and more information to try and trip me up so they can deny my claim. Thanks for any insight you can provide.
Tina, what MetLife is requesting is fairly typical in that they are looking to see if the SSA ever performed a reassessment of your benefit amount to see if you were paid correctly. This is separate from the COLA increase. It does happen that the SSA makes an error in computing the initial benefit amount and will go back and fix the mistake. Any adjustment on account of same would be subject to offset. If no such thing occurred with your case then you should have nothing to worry about.
I went out on ltd as a result of breast cancer, surgeries, complications and treatment. MetLife LTD approved my claim. At the tail end of chemo I began to experience severe depression, anxiety, struggled to get out of bed and take care of myself, suicidal thoughts etc, as well as progressing cognitive issues (either chemobrain or result of psychological issues) I tried to return to work twice but was unsuccessful and struggled significantly (I previously had outstanding/strong work history) and MetLife approved continued LTD. It’s never been my concern about what my diagnosis’s are. I’ve done extensive inpatient/outpatient, medication, ECT and therapy without progress. I’ve applied for many studies and trials but have been disqualified for one reason or another. I’ve had multiple DX as they appear to be subjective and many of them have over 60-80% overlapping symptoms. Now MetLife is denying my claim saying there is a 2 year benefit max for depression.
However, we’ve since concluded I’m bipolar but irregardless BPD and MDD symptoms overlap. Recently SSD approved my claim (but benefits are si small I’m only 41) why is MetLife able to set limitations for one dx and not other? Also, I still fight to stay alive each day. If I lost my leg they would cover it period. Also, my cancer kicked off this downward spiral and there’s no limition in that DX so again, I don’t understand the denial. I don’t know the root cause of my symptoms, my cognitive issues; I don’t know if it’s PTSD from cancer treatment and loosing my breasts (I couldn’t afford implants) maybe there’s some underlying issue from that.
Do you think I can prove discrimination of coverage for mental defect or treating people differently? All I want is for them to continue to cover me (60%) until I can productively return to work. Please help.
Bridget, unfortunately, a carrier can limit payment for a variety of conditions. Mental health limitations of 24 months are common to almost every disability insurance policy. There are similar limitations for a variety of medical conditions. These limitations have been deemed enforceable by the courts.
I am on STD with Metlife through my employer for severe depression, anxiety, stress and migraines. When I first went out on STD I was out and approved for Fibromyalgia, Deg. disc disease and sciatica. Metlife sent me to a Independent med exam and the examiner said I could return to work.
I did not go back to work bcs I was also seeing a Neurologist, Psychiatrist and Therapist for my depression, stress, migraines, etc. Metlife sent me to a second independent examiner this time for my psychological problems. The Independent examiner agreed with my dr’s and my diagnosis to keep my out of work. Under the psychological diagnosis I have been out of work for 5 Months and now Metlife wants to send me to ANOTHER Independent medical exam even though my Psychiatrist, Therapist and Neurologist have all turned in paperwork of my office notes and medication. They said the previous independent medical exam was only good for 90 days and they have scheduled me for another independent exam.
Can they do that if I’ve already had one independent medical examiner who already agreed with my dr’s?
Casandra, although it is not common for two IMEs in such a short period of time, due to the fact it is a STD claim and not LTD they would have a right to request, especially if the IME doctor is for a review of a medical condition not previously assessed in the prior IME.
I am on LTD with Metlife due to severe degenerative disc disease and radiculopathy in my back. I’ve had 3 level cervical spinal fusion as a result, and also deal with seronegative rheumatoid arthritis, fibromyalgia, precancerous anal cancer lesions with repeated surgeries, and hypothyroidism. My doctor has said the last two years I’ve reached maximum medical improvement and will not release me to work. The most recent forms sent indicate I can sit/stand intermittently 4 hrs daily, turn/twist 1 hr, and lift up to 20 pounds. I had a call from the vocational expert with Metlife last Thursday. From the tone of the conversation, it sounds like she’s trying to fit my existing skills into a part time job. She said they reached the decision that I cannot obtain gainful employment in my area due to my previous wages (their calculations make the wage I’d need to earn too high), and that my current condition of radiculopathy do qualify me for permanent disability. I was extremely blunt with her, telling her exactly what I can and cannot do, and even provided comparisons to previous employment with my current condition and how ridiculous it’d be to believe I could do them. At the end of the conversation, she said she’d get with the nurse and my claims manager to see what the next steps would be.
My 24 months of the “own occupation” ends January 8, 2017 then I’m to transition to the “any occupation”. My question boils down to CAN Metlife force me back to work part time if my doctors are saying NO?? Can they say I AM able to work even though the doctors are saying NO?? I went on short term disability June 29, 2015 and immediately qualified for SSDI; I’ve been receiving SSDI since the waiting period expired in December 2015. I’ve provided substantial medical evidence and documentation to Metlife, timely, and have been very diligent to handle any questions or documents immediately. I cannot believe the conversation from Thursday and am at a loss if I should be concerned, let it rest for right now, or get ready for a fight.
Bluetechseeker, MetLife cannot force you to return to work, but they can determine that based upon their review you would be able to return to work and deny the claim. The any occupation review is a common point in the claim that any insurance carrier denies a claim based upon the medical review of one of its doctors. Please feel free to contact our office to discuss your claim in greater detail, with specific attention to the pending any occupation review.
Hi!
Attorneys,
I was in car accident and broke my foot in September. My doctor wanted to place me on STD but persuaded her to let me work from home just to see if i could do it and to see if my job would approve it. My job approved it but continued to press me about my return and i even had to go in in my condition — unable to walk or put weight on my foot — because she couldn’t afford to have 2 employees absent on the same day. Additionally, my mgr contacted me about their inventory issues they needed my laptop & printer back.
While I tried to work home for a month, my foot got worst and wasn’t healing. So, immediately my doctor restricted me from working. My heel turned black and hard due circulation issues and not having my foot elevated by sittiing at an uncomfortable table sometimes 12 hours a day. Also, due not to healing properly, a blood clot developed in my leg of foot that was injured. After staying on Metlife for almost a month they finally approved my claim for only 3, then all of sudden suspended my case. Since day one it’s a challenge getting in contact with my case manager, she doesn’t return calls, I’m always sent to her vm. After several attempts she informed that they needed my doctor notes because they are trying to understand why I can’t work because my job is sedentary.
I sent them over my medical file with xrays and ultrasounds. Before I was even able submit all the info, yesterday I received a letter from a recovery agency and point I don’t know what else to do. Can you help me?
MWed, please feel free to contact our office to discuss your case in greater detail to determine what we can do to assist you.
I signed up for a 13 week plan with Metlife for Short Term Disability. I went on maternity leave. I was given 5 weeks of benefits (due to the 1 week waiting period). At my 6 week check up I was not cleared to return to work. I sent the forms over to Metlife to extend my claim. They closed the claim stating that I reached the maximum allowed benefit. The benefit for maternity leave is 6 weeks (technically 5 weeks) but I wasn’t cleared to return to work for medical reasons (they spoke with the doctor as well). If I paid into a 13 week plan, I’m not understanding why the claim was closed.
Kenya, without seeing a denial letter to determine their basis – though I suspect it would be they are of the opinion you were no long disabled – we would not be able to speak as to your legal rights. Please feel free to contact our office to discuss in greater detail.
Please assist me, I’m beyond stressed out. MetLife denied my claim for short term disability.
Trina, please feel free to contact our office to discuss the denial.
I was happy that for the past several years that I checked the box for std and Ltd at my place of of employment. After not spending a single day in the hospital ever 2.5 years ago I started to have severe right leg pain and burn. 5 surgery’s later for this and arthritis my pain still continues. But at 2 years Metlife said I could hold a job and cut me off COLD. Keep in mind my job was retail management at 50 hours a week.
Paul, have you appealed the denial yet? If not, it is imperative that an appeal is submitted within 180 days of the deadline to preserve your legal rights. Please feel free to contact our office to discuss your denial of benefits and your rights and options as they relate to the appeal process.
2010 I was injured at work as an employee of Kaiser. The injury was accepted as a California Worker’s Comp claim. This claim is still in progress. Within four weeks of the injury Kaiser had a round of lay-offs. I was laid off. My Worker’s comp case payments continued through the two year maximum and then stopped. Luckily I had a Met-life policy, paid for by Kaiser, which has picked up the slack. Just recently I had an Epiphany:
Is Met-Life responsible for continuing my Kaiser premiums in addition to the salary?
Are the monies received, via W-2, taxable? My contention is they are NOT as per IRS:
Tax Guide /Publication 17/ Catalog Number 10311G
Workers’ Compensation
Amounts you receive as workers’ compensation
for an occupational sickness or injury are fully
exempt from tax if they’re paid under a workers’
compensation act or a statute in the nature of a
workers’ compensation act. The exemption also
applies to your survivors. The exemption, however,
doesn’t apply to retirement plan benefits
you receive based on your age, length of service,
or prior contributions to the plan, even if you
retired because of an occupational sickness or injury
I’m a financial Professional for a large firm mostly compensated by commissions and fees administered by MetLife. I cannot get an answer as to whether I qualify for disability before I apply. My business would be destroyed once I go on disability, short term, and unable to get long term disability. I am headed for dialysis in the very near future. 1.) how can I find out if I would qualify for disability under those circumstances and 2.) if I receive a Kidney transplant can they take the disability away? I would have no business after spending 20+ years building one. Its too much a risk.
Richard,
I apologize, but I do not handle worker’s comp claims and am not an accountant. My specialty is in private disability claims. I suggest you contact a workers comp lawyer and an accountant.
Jesse,
The best thing to do is to call my office and ask for Rachel Alters and I can give you a free consultation. I would need to see a copy of your disability policies. You can reach me at 888-729-3355.
My father receives long term disability from Met Life. He was awarded disability from the Social Security Administration, and received a lump sum. Will he have to pay money back to Met Life, like subrogation, or will Met Life just decrease his benefit payments according to what he is being paid through the Social Security Administration. He has also received his disability retirement in a lump sum. Will that affect his payments too? I’m a legal assistant and am reading over the policies that his company had with Met Life, but I have to say it is rather confusing, even for me. Thanks!
Brandi, look at the “Other Income Offset” section of the MetLife policy, which will specify which types of “other income” they will offset for and the manner in which they will take the offset. In general SSDI benefits are offset on a monthly basis and any back benefit award would result in an overpayment that will have to be paid back to MetLife, separate from the ongoing monthly benefit offset. It is likely that his disability retirement lump sum will also result in some form of offset/overpayment. Depending on the Policy language, they will likely offset on a monthly basis for some length of time into the future. I suggest you contact our office and speak with one of the attorneys to discuss your situation in more detail.
Met Life is our LTD provider who has determined through their 2nd Physician Clinical Review that my husbands sudden onset of behavioral health issues from the frontal lobe stroke classifies as a mental health claim therefore only covering us for 18 months vs. 2 years. We have provided MRI’s, SpecScans, Neurological Testing results etc. and the list goes on and on that prove the brain injury. He was a high functioning, 30 year corporate executive career man who suddenly lost his capability. We have been through every possible treatment for the “Mental Health” disorders which have wasted almost 3 years of the wrong treatments. He has been hospitalized 4 times in 2 years due to medication failures that made him even more disabled, when he could have been spending his time rehabbing his cognitive deficits with stroke related programs of which he could never get the insurance or local hospital programs to approve him for due to his physical abilities to care for himself i.e., feed, use restroom etc. were not an issue.
However, his memory loss issues are huge and his ability to process information and retain a thought, along with massive depressive disorder and anxiety have been at times chronic issues. Since our SSDI has been approved we have had to pay back over $53k in back payments which we understand, but now they want access to our Social Security Files, which I’m reluctant to approve. What will they take from us next? They claim they want to help us, but I’m not so sure this is a safe gamble.
C. Packer, it is normal for a disability carrier to request a copy of the SSDI file. If the SSDI file contains evidence that your husband’s disability is due to a brain injury and not due to a mental health condition then it may benefit him to provide a copy of the file to MetLife. Please contact our office to speak with one our attorneys regarding your husband’s options.
Waiting on disability, I filed a claim with met through One Main financial with MetLife. They told me when I first told them I had Lupus that I would be fine with the disability portion, so I opt yes to make the payments. The recently denied my claim for pre-existing condition. I was taking back because payments were taking and I can’t use the insurance due to a pre-existing and I feel I was robbed. I paid a premium to a company that I in for of my illness.
Cashena, pre-existing condition claims are not always as simple and clear cut as the carrier tries to make them seem. There can be many factors that remove the claim out from under the pre-existing condition provision. I suggest you contact our office and speak with one of the attorneys to address your specific questions regarding your situation.
Metlife requested a ridiculous amount of paperwork for both the STD and LTD claims. The STD was not too bad since it was paid thru my employer. Metlife used numerous stall tactics on my LTD claim when they thought they were going to have to pay the full amount. Then when they received word that my SSDI claim was approved in 3 weeks and the amount that I and my daughter received on SSDI exceeded what they would have had to pay, then it was approved quickly. I did have a minimum of $100.00 a month pay out from Metlife, however you have to pay a minimum of $88.00 a month in Federal (sick pay) taxes, so the net pay from Metlife to me is $12.00 a month. Now after I received my first $12.00 payment, they send me a notice that I have to send all of my files that were sent to SSDI to them AT MY EXPENSE or they will have to review my claim. One of the documents you MUST sign for the LTD application is a release form giving Metlife the right to all files DIRECTLY from the SSA. Now why would Metlife demand that you give them a release for all your SSA files and then tell you that you MUST send them all your SSDI file or be subject to a review after one month of claim which again was a whopping $12.00. If Metlife if doing this to me over $12.00, I can only imagine what they are doing to people that they have to pay the full amount. It is obvious that Metlife has deep political roots involved in being able to run the company this way. I would love to know who the politicians are that they own before the mid-term elections.
I have a disability policy through work. I have been receiving payments for the past 9 years. After the first two years I stopped seeing a physician as I suffer from multiple radicuopathies after two unsuccessful surgeries I’m unable to sit or stand for a short period of time.
Recently, Metlife has sent me their usual annual forms which I respond in writing that I am not required to be under a physicians care after the first two years and that I am not, and therefore cannot provide them with the information. This year they have conditioned sending addtional notificiations until the “final notice” within 15 days to respond. I have asked them to tell me what I am doing wrong. What can I do and they refuse to answer my responses. They don’t want any other informatoin such as pain management, they are only interested in a physician’s assessment.
Metlife does have the right to send me to a physician for evaluation under my contract but they have not indicated that they wish to do so. Shouldn’t they be requried to have information that is contrary to my disability, or at least seek that information before simply terminating my benefits? They have never disputed my claims in the past. I have insisted that all cooresponance bein writing after one of their “managers” wanted me to lie to my doctor in order to acquire information, and then wanted me to have my pain managment doctor commit a felony by filling out the forms which is not qualified to do so. That’s when I said, put your requests in writing from now on. Since then, there have been two or three of the annual physician requests but no responses to mine.
Doug, you should contact one of our attorneys as soon as possible to discuss your options.
I stopped receiving benefits from MetLife a few months ago due to a 24 month limitation of payments for Muscular Skeketal diseases which I have. Is there ever success appealing that and getting benefits reinstated? My issue is I’m still in the discovery phase of my disability. The doctor has already said I’m not “curable” and am totally disabled but I’m also still receiving new diagnoses and have issues not yet addressed.
Angie, there are exceptions to that limitation such as radiculopathy and myelopathy. Have your doctor test you for those conditions, or any of the exceptions listed in your policy. You have 180 days to appeal the determination. Please contact me via email if you would like a free legal consultation, Rachel @diattorney.com. Rachel Alters, Esq.
I lost my job with a class 1 railroad due to color vision issues and have been on LTD for three months. I am able to work (not in the RR industry) and will continue to receive some LTD benefits as long as I make less than 80% of my pre disability income. This percentage reduces to 70% after two years.
My question is, can Metlife determine on their own that I am capable of earning over 70% of my pre disability income based on my education and experience? Can they do this even if I have a job under the 70% threshold?
Tim, yes, I suppose they could hire a vocational expert to give the opinion that you are capable of earning more money than you re at your current job.
Question concerning my Met-Life Disability plan, which was company provided via monthly deductions from my paycheck along with all my other benefits.
*First Half of 2014 I worked full-time for a large corporation, however 2nd half of 2014 I became disabled.
*In addition first half of 2014 I performed part-time side work as a sole proprietor, earning $3,000 but the money was not paid to me until the end of the year, after which I had become disabled!
*I never imagined I would abruptly become disabled, doing the side-job I agreed to get paid at the end of the year to make sure my advice worked for the company.
*Now Met-Life just requested tax returns…
Q: Will the late payment I received in 2014 the same year I became disabled be clawed back as overpayment?
James, more than likely it will be considered an offset under your policy. How they compute the offset will depend on whether your policy has provisions related to return to work incentives or even a true partial/residual disability provision. Regardless, work earnings while on disability typically result in some sort of reduction in monthly benefit based. If you would like to discuss your situation further, please feel free to contact our office.
In a letter to my lawyer regarding my own occupation individual disability claim (not ERISA), based on the evaluation by the workman’s comp provider [who finds that practically everyone has a not covered emotional issued instead of a ‘real’ issue], my disability company stated that they find the restrictions and limitations resulting from my impairment are not substantiated. This impairment was one of several medical issues for which I claimed disability. They do not seem to be disputing the other medical issues, and I have provided objective documentation, including from my job and my providers. My case is still under initial evaluation and review. In response, I obtained and turned in more objective evidence supporting my claim. I am under the impression that my case has not yet reached the appeal stage for the following reasons: 1)They haven’t made an official ruling on my case for granting disability, so turning in further documentation can’t be an appeal. 2) The letter from the disability company does not mention the word appeal. Is this an accurate assumption?
My policy does not mention that my job definition is from that of the national economy. Does that mean I can argue the specifics of my particular job requirements, or am I still stuck with some sort of generic?
My policy states that they require proof of loss for each month that I claim benefits, and this must be turned in within a specified period of time. At this point I have not even been approved or denied for benefits. My lawyer says I don’t need to turn in retroactive ones, just one each time they request it, because my claim is still pending. I’m concerned as I am up on the deadline. Does my initial proof of loss form submitted a few months ago cover all the months preceding, or do I really need to write out a separate monthly form even though I don’t even have any benefits yet? At the rate they are moving they will decide on my benefits after the deadline has passed. Three lawyers have told me it is not necessary, and that my disability can’t require proof of loss from dates prior to when they pay me, but I’m worried they will try to void my policy if I don’t turn in these forms monthly all the way back to the month I stated my disability started on my initial claim form. I would hate to get screwed for such a stupid reason. Am I being overly cautious?
Watching, you have raised many significant questions as well as the fact that you currently have an attorney representing you in your disability matter. Given the circumstances, I suggest you contact our office and speak with one of the attorneys to address each of the specific questions you have regarding your situation.
I was recently approved SSDI at DDS level, no backpay and $200 more than what I was receiving from MetLife. The information was sent to MetLife a month after the attorney was paid with no response, so I sent again, this time requiring a signature. Embarrassed to say, I spent the 2 additional checks. I finally got a letter from their offset group requesting official document from SSA about attorney fees so they could figure my offset while they review my case. In addition to this issue, I originally applied almost 3 years ago and was denied. Above case was me starting over. In November 2016, I took out my pension in the amount of $7068 after taxes from my company, MetLife reduced my payments by $23 to pay them back. My claim was approved until December 2030. Even at $23 per month, it would be impossible to pay them back. There is a provision in my policy that states I will get 10% of my monthly, which I figure would be the $200 – $23. which would more than pay back the pension and the 2 additional checks by a long shot. My math isn’t that great, I know there’s probably some weird formula they use, but all in all, the amount left on my claim from now to December 2020 is about $24000.
Sorry for long explanation. My concern is this…every time I see review of claim, they make me nervous. Even with SSA doctor & psychiatrist backing the approval, I feel such anxiety my mental state suddenly went haywire. As you may have noticed, I’m all over the place. I apologize. With no insurance and my son filing bankruptcy because my medical bills, my doctors, psychiatrist, therapist visits right now are less than before. I won’t have Medicare for 2 years, so a review will show less information. The review could cause a denial from MetLife. If that happens, how do I, on a limited budget, pay MetLife back the 2 months plus the pension? And am I obligated to pay them back more for all these years? I refuse to appeal. I can’t. It has caused me more health problems, exacerbated the bipolar, anxiety etc,. Not to mention, I’m past the window to appeal with SSA. I hope you understand my questions. Oh yeah, my review with SSA is listed as 5-7 years and I’m 53, 54 in December. I suppose statistically they assume I’ll die before then. Morbid, but probably true. I just got the letter yesterday dated the 6th and have 30 days from that date to respond. MetLife is funny like that. Letter mailed from Kentucky took 6 days to get here. That’s always the case with them.
I would call but at this point have not been denied or threatened. It’s just a feeling. Oh yeah again. I don’t pay taxes on my payments from MetLife. I think I covered everything. The policy says they are entitled to backpay and I have to appeal. I did that once, so I feel like I fulfilled that. I just couldn’t do it again.
My daughter is on short term disability for stress and anxiety as a result of a sexual assault. She is being treated by her primary care physician medically (off work, medication and follow up treatment); and is also in therapy through an advocacy group. Met Life was paying out her claim until recently, stating they needed the therapy notes from the sessions, which we feel is a violation of her medical privacy to require specific details of her personal trauma. In addition, the Therapy Group does not provide the requested information; only basic information, patient, treated for, treated from this day to present, etc. The Primary Care Physician has submitted the information requested by Met Life and as the Primary Doctor, we feel we have met the required burden of proof (which in itself is ridiculous). Met Life was paying out her claim (without the new requirement) until now. Met life has not formally denied her claim, but has her in limbo; we believe in an effort to have her get frustrated and give up. Can Met Life legally make this a condition of receiving benefits, given the Therapist is not the Primary Care Phyisian? Is this something you would be able to help with?
Mike, I would be happy to speak with you about your daughter’s Met Life claim. Please email me at Rachel@diattorney.com or call me at 888-729-3355 and ask for Rachel Alters, Esq.