MetLife Approves Long Term Disability Claim For Executive Assistant with Neck Pain
Our client, a former Executive Assistant at American Express, filed a claim with MetLife under American Express’s short term disability policy on account of severe cervical and thoracic pain with resulting radiculopathy that made it impossible for her to execute her job duties. Based on the medical information provided, MetLife quickly approved our client’s for claim for short term disability with little resistance. However, as the short term disability period began to reach its end our client began to experience a different side of MetLife.
The transition to Long Term Disability
Like the vast majority of short term disability policies, our client’s policy was funded by her employer, but was administered by MetLife – meaning the actual payment of short term disability benefits was paid by American Express and MetLife’s only responsibility was to advise American Express if the claim was approved or denied. As such, MetLife was not financially vested in her short term disability claim. However, as the long term disability policy was underwritten by MetLife, MetLife would be responsible for paying any resulting long term disability benefits. When it became evident that our client would not be able to return to work and that she would need to file for long term disability benefits, MetLife’s attitude towards her changed.
All of a sudden medical information provided was “not received” or when it was, it was deemed unsupportive of disability. Essentially, the same information MetLife used to approve short term disability benefits was now being used in an attempt to deny her long term disability benefits. Our client remained hopeful that MetLife would do the right thing and pay her benefits, but with each passing week without pay her financial hardship only worsened. After feeling defeated and getting nowhere with MetLife she contacted our office and spoke with Attorney Stephen Jessup. After discussing all that had transpired with Attorney Jessup she retained his services to takeover handling the claim with MetLife.
Attorney Jessup immediately contacted MetLife to advise the claims manager of our representation and set to work on gathering the information needed to ensure our client’s claim would be approved. Based on his experience in dealing with MetLife disability claims, Attorney Jessup knew that MetLife was making two arguments with which to try to deny our client’s claim:
- As our client had been working with her medical condition for some time MetLife was questioning why she needed to file for disability now. Essentially, MetLife was asking, “What changed?”
- A lack of objective medical evidence to support restrictions and limitations. This is a very common position to take when the basis of disability is pain related. MetLife will argue that the complaints are all subjective and not verifiable. This is the commonly used “Diagnosis does not equal disability” argument from MetLife.
Attorney Jessup has dealt with these issues numerous times and knew it would be important for our client to get an updated MRI to document “what changed” and to undergo a Functional Capacity Examination in order to verify that our client’s “diagnosis did equal disability.” The updated MRI indicated that our client’s condition had in fact worsened since the prior MRI performed two years earlier. Attorney Jessup knew this would greatly assisted in responding to MetLife’s “what changed” argument. All that was left was to have the Functional Capacity Examination performed.
Medical File Review
As Attorney Jessup was working with our client and her doctors to gather the necessary medical information MetLife forwarded a copy of a medical file review performed by one of its doctors and requested that our client’s doctor respond to the findings therein. Any time an insurance company sends a medical review and requests a response it is clear that their intention is to deny the claim. In the letter MetLife gave a limited timeframe with which to respond, the deadline of which came two days before our client was scheduled to undergo her FCE.
MetLife’s medical review contained a glaring problem – when rendering his opinion, the doctor did not have all of the applicable medical documentation – specifically he did not have the updated MRI. On March 6 our office provided MetLife with the updated MRI findings. However, the medical review was completed on March 4 and the doctor relied on the earlier MRI from two years prior. This MRI information ultimately led MetLife’s doctor to render an opinion that our client would be physically able to perform her work duties. This would have been an excusable mistake but for the fact that despite having the updated MRI on March 6, MetLife didn’t provide it to the doctor and request he consider it and issue any addendum to his report on account of same. Instead, MetLife sent the doctor’s report to our office on March 11 for review and comment.
The day after we received MetLife’s doctor’s report the COVID-19 pandemic swept the country, and our client – a resident of New York City found herself in a citywide lockdown. Needless to say the FCE would not occur for the foreseeable future. Despite this extraordinary situation MetLife denied all extensions to provide information. Attorney Jessup responded in full as to MetLife’s failure to provide crucial medical information to its doctor, and without the ability to have the FCE testing performed, worked with our client’s doctor to provide a response to MetLife’s medical review.
Approval
After nearly another week without pay and filled with uncertainty and fear as our client was isolated in her apartment as the coronavirus brought New York City to a standstill, MetLife notified our office that it was approving our client’s claim for benefits. Had MetLife provided the updated MRI to its doctor when they received in on March 6 there stands a good chance that our client’s claim would have been approved weeks earlier.
Our client believes had she tried to deal with MetLife on her own they would not have approved her claim. Her claim serves as an unfortunate example of how MetLife will try to look to deny a claim for long term disability as it transitions from a period of short term disability.
If you are having issues with MetLife paying your claim or have any questions regarding a MetLife disability issue, please do not hesitate to contact our office to speak with one of our disability attorneys.
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MetLife Reviews
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Policy Holder Rating
5
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58%
1
41%
Timely Payments
2.1out of 5
Handling Claim
1.9out of 5
Customer Service
2.1out of 5
Dependable
1.9out of 5
Value
2.0out of 5
Showing 8 of 660 Reviews
MetLife
They will do anything to not approve your claim
MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
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MetLife
They FULL OF ****
MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >
MetLife
MetLife for disability? Avoid the surgery unless it's life-threatening
The worst company I ever dealt with, never received a call from my claim manager.
MetLife
Only care about $$$$$
PLAY THEIR GAME FIGHT FIRE WITH FIRE.....after getting a copy of the insurance policy from my HR. I nipped a lot of the headaches quickly by calling their bluff word for w... read more >
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MetLife
They demanded an overpayment, stopped my claim, and lied about it
Metlife over paid me. Stopped my Ltd claim. The overpayment were not done right. They lied and said they deposited money in my account.
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MetLife
Your decision making process is absurd!
My wife went through a nightmare with a back surgery for two discs. When the first surgery took place, the Dr. cracked a different vertebrae as they placed the metal rods ... read more >
MetLife
My husband has 2-5 yrs to live, yet MetLife has been giving him the run around
My husband has STD and LTD with his employer. He was dx with ALS/Lou Gehrig’s Disease Aug 2019, made official after many many test, as of Jan 2020 but continued to work ... read more >
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MetLife
Inappropriate conduct!! Rude, discriminatory, etc
Have you ever dealt with a case where the person is receiving LTD benefits but there have been issues with the case manager? For instance, the person was badgered about an... read more >
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Answered Questions by Our Lawyers
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Showing 8 of 76 Answered Questions
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A: Jim:If this payment is a form of a retirement or pension payment then it is likely correct for Metlife to of... Read More >
Q: Do I have an option after my appeal is denied?
A: Lauren:If your appeal is denied by MetLife then you have the option to file lawsuit in federal court. Read More >
Q: My daughter died in 2019
A: If your daughter was disabled prior to being terminated then she should have coverage. Read More >
Q: Can I sue Metlife for non payment of approved claim?
A: Unfortunately, the answer is "not liklely." I would assume your MetLife policy is an employer provided policy ... Read More >
Q: How far behind in payments does Metlife have to be to take legal action?
A: Make sure you put all of your requests in writing so there is a record should you end up in court. It’s best... Read More >
Q: Does Metlife pay Disability payments ahead? Example: December payment is for January.
A: Peg, most disability insurers pay monthly disability benefits in arrears, in other words, payments are made fo... Read More >
Q: Would any new disabling conditions be considered by Metlife when considering whether or not to continue my benefits?
A: The change in diagnosis will likely lead to denial so please explain the situation to your treating doctor. Me... Read More >
Q: MetLife: Mental Health and Physical Disabilities
A: If you have physical disabilities that prevent you from working then you have options to get around the mental... Read More >
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MetLife Approves Long Term Disability Claim For Executive Assistant with Neck Pain
Our client, a former Executive Assistant at American Express, filed a claim with MetLife under American Express's short term disability policy on account of severe cervical and thoracic pain with resulting radiculopathy that made it impossible for her to execute her job duties. Based on the medical information provided, MetLife quickly approved our client's for claim for short term disability with little resis... Read More >
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Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
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Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
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We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
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