Facing a MetLife disability claim denial can be a frustrating and stressful experience. However, you don't have to give up on the benefits you deserve. Professionals in the field can always help you with the appeals process and building a strong case.
This guide equips you with the knowledge and tools to undergo the appeals process and develop a compelling case for your MetLife disability appeal.
The first step is understanding the stages involved in appealing a MetLife disability claim denials. MetLife offers an internal appeals process before allowing you to pursue external options.
● Internal Appeal: This is your first opportunity to challenge MetLife’s decision. You'll typically have 60 days to submit your appeal, although this timeframe can vary. Gather supporting documentation and submit a formal appeal letter outlining why you believe the initial denial was incorrect.
● External Review: If your internal appeal is unsuccessful, you can take your case to an independent reviewer chosen by MetLife. This reviewer will evaluate your case and MetLife’s decision.
● Lawsuit: If the external review upholds the denial, you have the right to file a lawsuit against MetLife. However, this path typically requires legal representation and can be a lengthy process.
Building a strong case hinges on gathering comprehensive and compelling evidence that supports your claim of disability. Here are key documents to include in your appeal:
Medical Records:
● Ensure you submit complete and up-to-date medical records from your treating physicians. These records should document your diagnosis, limitations, and treatment history.
● Consider obtaining additional medical opinions from specialists if your diagnosis is complex or your limitations are not fully documented.
Functional Capacity Evaluations (FCEs):
An FCE is an objective assessment designed to measure your ability to perform various physical and mental tasks related to your job.
Work with your doctor to ensure the FCE accurately reflects your current limitations. This may involve requesting specific tests or adaptations to the FCE protocol.
Employment Documentation:
Gather documents from your employer that outline your job duties and the physical and mental demands of your position. Include performance evaluations that demonstrate your past ability to perform your job and any documentation of disability accommodations you previously received.
Your appeal letter serves as a critical element in presenting your case to MetLife. Here's what to include:
Structure and Format:
● Maintain a professional tone and format your letter clearly with your contact information, date, and addressee.
● State the purpose of your letter as appealing a disability claim denial.
● Include your claim number and the date of the initial denial.
● Addressing the Denial:
○ Specifically address the reasons for denial outlined by MetLife in your denial letter.
○ Avoid simply restating the denial reasons; explain why you believe their assessment is inaccurate.
Highlighting Evidence:
● Briefly mention the key pieces of evidence you've included in your appeal package that support your claim.
● Do not overwhelm the reader with technical details but highlight the most impactful aspects of your medical records, FCE results, and employment documentation.
Desire to Return to Work (if applicable):
If your goal is to eventually return to work, express this desire in your appeal letter.
You can offer to work with MetLife to explore vocational rehabilitation options or modified duties that might allow you to re-enter the workforce with your limitations.
While a strong case is essential, consider these additional strategies to bolster your appeal:
Legal Representation:
● Consulting with a lawyer experienced in disability insurance appeals can significantly increase your chances of success.
● An attorney can navigate the complex legalities of the appeal process, ensure you meet all deadlines and effectively present your case to MetLife or an external reviewer.
● Consider seeking a lawyer specializing in MetLife disability claims who understands the insurer's specific policies and procedures.
Communication and Documentation:
● Maintain organized records of all communication with MetLife throughout the appeal process. Keep copies of letters, emails, and phone call logs.
● Submitting all requested information promptly demonstrates your seriousness and helps the appeal process progress smoothly.
Building a strong case for your MetLife appeal requires proactive steps and meticulous documentation. By gathering comprehensive medical records, participating in functional capacity evaluations, and obtaining relevant employment documents, you can present a compelling case that supports your claim. Remember, a well-crafted appeal letter that addresses MetLife’s specific reasons for denial is crucial. Consider seeking legal representation from an experienced disability insurance lawyer to navigate the legalities of the process and maximize your chances of success.
Throughout the appeal, maintain clear communication with all parties involved and remember to stay persistent. Don't be afraid to advocate for yourself and the benefits you deserve.
