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Marc Whitehead
Board Certified-Personal Injury Trial Law
Texas Board of Legal Specialization

 

 

 

MetLife Disability Claims Denial



Experienced MetLife Disability Claims Denial & Appeal Attorneys

Founded over 140 years ago, today MetLife (Metropolitan Life Insurance Company) is a global leader in the insurance industry. They sell an expanse of insurance products including disability, life, dental, auto, home and long term care insurance.

MetLife sells disability insurance policies that individuals may purchase privately. To employers, MetLife provides short-term and long-term group disability insurance for employee benefits. MetLife also acts as the administrator of group disability insurance plans.

When you become disabled and need to claim disability income, your benefits are not always easy to obtain. An active part of our practice is protecting MetLife policyholders when they have been wrongly denied disability income.

Appealing a MetLife Disability Claims Denial

If you or a loved one is a policyholder of MetLife disability insurance and your claim has been denied, do not delay. Contact Marc Whitehead & Associates for a free case evaluation, or call us toll free at 800-562-9830. We can help you in any location in the United States. Don't Give Up! Call for a Free Consultation.

Here is a key point to know: As a service of their group disability plans, MetLife acts as both the evaluator of the claim, and the payer of the claim. This dual role can create serious conflict of interest. Such a conflict may serve in the best interest of the insurance company and not the disabled claimant. In fact, it is common for insurance companies to both determine and pay benefit claims.

MetLife disability claims denial involving group disability plans are governed by federal law known as ERISA. Most attorneys are not familiar with the nuances in ERISA governed claims. Under ERISA, a claimant’s rights are limited. Courts are confined - by law - to follow specific standards of review.

A court may consider conflict of interest as a factor in a case; however, most often the presence of a conflict does not influence the outcome. What this means is, the court will generally uphold a denial of benefits unless the court finds that the administrator (insurance company) “abused its discretion.”

Changes to these and other ERISA laws are rare. However, a recent Supreme Court case, in which MetLife denied a claim for long term disability, required the court to scrutinize MetLife’s role as both evaluator and payer of the claim. The case - Metropolitan Life Insurance Co. v. Glenn 28 S.Ct. 2343 (2008) - went beyond the normal considerations of conflict of interest and resulted in favor of the disabled claimant.

Metropolitan Life v. Glenn

A Sears employee, Wanda Glenn, suffered a disabling heart condition in 2000. Glenn applied for LTD benefits under Sears’ employee benefits plan though MetLife.

MetLife had both the discretionary authority to determine whether Glenn’s case was valid, and to act as the payer of the benefits. MetLife initially determined that Glenn could not perform the duties of her own job, and granted Glenn a 24-month disability benefit.

MetLife also told Glenn to apply for Social Security disability benefits. In 2002, Glenn was found by the Social Security Administration to be not only disabled from her “own” job, but also disabled from performing “any” job for which she was reasonably qualified.

Glenn was awarded permanent disability payments by the Social Security Administration retroactive to April 2000. Three-fourths of the Social Security benefits went to MetLife as an offset rather than to Glenn; the rest went to attorney fees.

Glenn then applied for MetLife long term disability. MetLife denied this claim, saying that her condition had improved to the point that she was no longer totally disabled - even though the Social Security Administration found Glenn totally disabled.

Glenn challenged the MetLife disability claims denial in federal court. MetLife fought back, arguing that it was entitled to the discretionary standard of review, as MetLife was entitled to discretion in making benefits determinations.

The federal district court reviewed the administrative record, and upheld MetLife’s denial of benefits. It found that “abuse of discretion” was the correct standard of review, and that MetLife had not abused this discretion.

Glenn then appealed to the U.S. Court of Appeals for the Sixth Circuit. The Sixth Circuit reversed the decision.

The Sixth Circuit Court of Appeals concluded that MetLife had a conflict of interest (MetLife both decides the claims and pays the claims) and that this conflict was a relevant factor in determining whether MetLife abused its discretion.

The Court ruled that MetLife had abused its discretion and ordered Glenn’s benefits to be paid by MetLife. The Sixth Circuit also factored in other serious concerns, including MetLife's failure to consider the Social Security Administration’s determination that Glenn was totally disabled.

MetLife appealed to the Supreme Court. In June of 2008, the Supreme Court ruled against MetLife and in favor of the decision of the Sixth Circuit.

Changes to Come

The court’s overturning of MetLife’s disability claims denial in this case may improve the standards for review of ERISA disability claims, and positively affect future ERISA litigation.

Conflict of interest will be given proper weight as a factor in finding abuse of discretion in denial of disability claims. It is realistic to expect that various Circuit Courts will deal with the impact of MetLife v. Glenn in different ways. Courts may now be more willing to allow attorneys representing disabled claimants to obtain discovery and admit evidence on behalf of their clients upon appeal.

Ask for Experienced Help for MetLife Disability Claims Denial

With or without new Supreme Court decisions, an in-depth understanding of ERISA law and the insurance industry is paramount when dealing with unfair disability denials.

At Marc Whitehead & Associates, we are changing our clients lives. Our approach to this decision, and how we will continue to help our disabled clients, is solidly based on our knowledge of ERISA law.

It all starts with a Free Consultation with a lawyer about your MetLife disability claims denial. Don't Give Up! Call for a Free Consultation. With our experience in ERISA appeals and litigation, together we will send a message to insurance companies that you are not going to be manipulated out of your rightful compensation.

Marc Whitehead & Associates handles MetLife long-term disability claim denials nationwide.


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