MetLife Disability Claim Tips for Physicians

Our law firm has extensive experience filing and litigating MetLife disability claims for physicians. Our attorneys understand how MetLife operates and what it takes to file a successful MetLife disability claim. If you would like to hear what other physicians have to say about us and see why our law firm is the best option for physicians filing disability claims, please visit our testimonials page.

Below are some answers to the most common questions our attorneys receive from physicians about the disability claim process, generally, and their MetLife disability benefits, specifically. If you’d like to discuss your particular claim with our attorneys, we are happy to set up a free consultation.

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1. Does MetLife have a good reputation for paying disability insurance claims? Can it be difficult for physicians to collect disability benefits under MetLife policies?

2. Does MetLife have true own occupation disability policies for physicians? Why is my MetLife policy referring to income offsets and what is a “Transitional Your Own Occupation” Benefit Rider?

3. Why does my MetLife policy have a “regular occupation period?” I thought my MetLife policy always defined my occupation as my medical specialty.

4. As a physician, how do I go about filing a disability claim with MetLife?

5. How long does it take to receive MetLife benefits?

6. MetLife is constantly asking me for a lot of paperwork. Is that normal or allowed?

7. Why does MetLife want to interview me? Should I be concerned that MetLife is sending someone to interview me in-person or at my house instead of asking me questions on the phone?

8. Why is MetLife requiring an in-person medical examination or IME? Can I limit the scope of the exam?

9. Does MetLife conduct surveillance in physician claims?

10. Why is MetLife asking for my personal/dental practice financials? Can I refuse to give them my private information? Should I let them speak with my accountant?

11. Why is MetLife’s doctor contacting my treating doctor directly?

12. Why is MetLife asking for such broadly worded authorization form to gather my records?

13. Can I file a disability claim with MetLife if my claim is due to a mental health condition like depression, anxiety or panic attacks?

14. Why is MetLife asking for “objective” medical evidence? And what if it isn’t available or applicable in my situation?

15. I am a physician with neck/back pain and my MetLife policy has a two-year limitation for neuromusculoskeletal disorders. Will I be able to collect?

16. I’ve heard that MetLife uses biased doctors. Is this true?

17. Do I need to hire a MetLife disability attorney to file my claim?

18. When should I contact an attorney about my MetLife disability claim?

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1. Does MetLife have a good reputation for paying disability insurance claims? Can it difficult for physicians to collect disability benefits under MetLife policies?

Unfortunately, in our experience, MetLife can be a particularly trying disability company to deal with on claims. At present, Unum and MetLife are the two disability companies that come up the most often in speaking with professionals who have had their claims denied. This also tracks with our weekly disability lawsuit alerts, where Unum and MetLife regular appear as the two disability companies that are being sued most often for denying benefits.

If you know anything about Unum’s history, this is not good company for MetLife to be in, and there are some notable parallels between the two.

For example, both Unum and MetLife have now left the private/individual sector of disability insurance, and no longer even sell private policies to physicians. Similarly, both have opted to focus on selling employer-sponsored disability plans instead, as those plans are governed by ERISA (a federal statute that preempts state remedies, such as bad faith damages, and can make it much more difficult to challenge wrongful claim denials).

Why does this matter? It means that, if you are a physician with an individual disability policy issued by MetLife, you are now part of a closed block of business where no new premiums are being generated. This means that MetLife makes money (or, rather, loses less money) on its individual policies only if it denies claims.

Additionally, we have noted that, over time, MetLife appears to have been emboldened by the perceived shield ERISA provides on other disability claims. A review of recent caselaw shows that MetLife has been pushing the limits on its claims handling in recent years, particularly in the ERISA arena. And, in our experience, this more aggressive approach has also spilled over into how they are handling private claims not governed by ERISA.

That being said, it is not impossible to collect benefits from MetLife. However, it is a situation where you may need attorneys involved to properly present the claim and document your claim file in a manner that gets MetLife’s attention.

Additionally, like Unum, once a claim has been denied, MetLife has shown a willingness to litigate and defend the denials for years, even if they have acted improperly and wrongfully denied the claim. Consequently, if you are filing a MetLife claim, it is very important that the claim is handled correctly from the start.

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2. Does MetLife have true own occupation disability policies for physicians? Why is my MetLife policy referring to income offsets and what is a “Transitional Your Own Occupation” Benefit Rider?

MetLife has “own occupation” disability policies but, for the most part, they are not “true own occupation” as they do not let you double-dip and work in a new occupation in the same manner as other disability policies. Depending on your specific policy, you may have some restrictions placed upon your ability to work in another role, even if you cannot practice medicine.

For example, your MetLife policy might have a “Transitional Your Own Occupation Benefit” rider that has “own occupation” in the title, but is not true own-occupation as we define it. Thus, the key description word in this rider is “transitional,” not “own occupation.”

While these “transitional” riders allow you to work in a different occupation and collect total disability benefits, they also typically cap the total income you can receive in any given month. This income cap is based upon a formula that factors in your prior income and other disability benefits you may be entitled to receive. In some instances, this can even include disability benefits from other sources than MetLife (such as a second policy purchased from a different disability insurer, disability benefits through your employer, or even Social Security disability benefits).

In our experience, these “transitional” riders cause the most confusion for the physicians calling in with MetLife policies, as they are complicated and often not in-line with the physicians’ expectations of their own disability coverage. But they are not the only aspects of MetLife policies that can make collecting “own occupation” benefits more difficult.

As just a few more examples, because MetLife uses riders to identify the scope of “own occupation” coverage, MetLife’s base disability policies often have “no-work” provisions. As a result, if you did not purchase additional “own occupation” riders, you may not be able to work in a different occupation and collect total disability benefits.

As another example, MetLife policies typically contain very strict definitions of total disability. While other disability companies may define total disability as being unable to perform “some” or “a majority” of the material and substantial duties of your occupation, MetLife policies define total disability as being unable to perform “each and every one” of the material and substantial duties of your occupation.

Consequently, it is important that you carefully review how total disability is defined in your MetLife policy before filing a disability claim. If you have questions about whether you have a total disability claim under your MetLife policy or if your claim will be subject to income caps and offsets, an experienced disability attorney can explain the scope of your coverage under your specific policy and any relevant “own occupation” riders.

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3. Why does my MetLife policy have a “regular occupation period?”  I thought my MetLife policy always defined my occupation as my medical specialty.

Many physicians—with MetLife policies or otherwise—mistakenly assume that their policy “defines” their “occupation” as “physician” (or their medical specialty) because they applied for the policy as a physician.

While this may be true, it is not always true, because “occupation” is typically a malleable term under professional disability policies and depends on what you were doing immediately prior to becoming disabled. Moreover, many disability policies, including MetLife policies, define occupation in the plural—i.e. the “occupation” or “occupations” that you were performing immediately prior to disability.

Thus, if you have multiple sources of income, in addition to the clinical practice of medicine, MetLife may refuse to pay total disability benefits even if you cannot practice clinically, if you can still perform the material and substantial duties of your other income-producing enterprises. While there can be disputes over what rises to the level of “occupation” for these purposes, MetLife pays close attention to all income sources and will ask for your tax returns and financials in order to determine if any non-clinical occupations can be identified.

Additionally, with MetLife, the definition of “occupation” can be further complicated by the fact that MetLife’s base policies often limit the “own occupation” or “regular occupation period” to a limited number of years (e.g. five years, or two years, etc.). While it is possible to pay higher premiums to extend the “regular occupation period” for the entire max benefit period, not every physician remembers to (or wants to) do that.

Thus, if you have a MetLife policy, you must read the policy carefully and not simply assume that your occupation with be “physician” for the entire benefit period or course of your claim.

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4. As a physician, how do I go about filing a disability claim with MetLife?

In order to file a MetLife disability claim, you must submit the proof of loss required under your MetLife policy. Most MetLife policies require this proof to be submitted in writing and within a certain time frame—typically within 20 or 30 days from the date of loss.

The first step is obtaining and submitting MetLife’s initial proof of loss packet, and will consist of several questionnaires for you to complete and sign, including an investigative authorization, along with a form with questions for your doctor to complete and sign. As you might imagine, these documents were created by attorneys and the questions directly relate to various provisions of your policy/riders that can be used to deny or limit your rights to total or partial disability benefits.

MetLife has an online portal that you can sign up for, if you have an employer-plan. But if you have an individual/private disability policy and are not represented by an attorney, you may need to call in personally to request the proof of loss packet.

When you call in, our attorneys have observed that MetLife may subject you to an impromptu interview, often on a recorded line, so you should be prepared to answer important questions impacting your claim the very first time you are on the line with them.

If you are planning on having an attorney represent you on your disability claim, it is better to consult with counsel prior to making this initial call, so that you are not subjected to questioning before securing legal representation.

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5. How long does it take to receive MetLife benefits?

After your date of disability, benefits are subject to an elimination period that must run before any benefits payable. Under most MetLife policies, these days do not have to be consecutive, but must be met within an accumulation period for the same or related cause of disability.

For example, typical of many MetLife policies, the elimination period is 90 days, with an accumulation period of 180 days. How long it will take for you to be eligible for benefits will depend on how many days of disability you have at the beginning, and whether they are consecutive or split by periods where you returned to work (or attempted to return to work unsuccessfully).

Disability insurance companies rarely approve claims prior to the elimination period running on the policy, and will not issue benefits until you have cleared that timeframe. As noted above, MetLife can be a more difficult company to deal with and may take longer to approve your claim and issue benefits.

Whether or not this is appropriate is something that is claim specific, and depends on the underlying facts and timeline. Oftentimes, payment can be delayed due to a lack of key information and, if you have never filed a disability claim before, it may be difficult for you to identify important proof of loss information that may be missing from your claim.

If you are concerned that MetLife is wrongfully delaying payment of disability benefits, an experienced disability attorney can review your claim and determine if there is a legitimate basis for the delay.

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6. MetLife is constantly asking me for a lot of paperwork. Is that normal or allowed?

MetLife policies have robust “Proof of Loss” requirements, which include a contractual right for MetLife to require monthly proof of loss. This is most often requested in the form of updated progress reports from you and updated physician’s statements from your doctor, accompanied by the applicable insurance fraud warning language required by your particular state.

While it is not uncommon for disability insurers to continue to ask for updates and forms periodically during the life of a claim, in our experience, MetLife tends to invoke the monthly proof of loss requirement more than other disability insurers. We’ve seen MetLife continue to require monthly proof of loss, before issuing benefits, even in situations where physicians have conditions that are clearly chronic and progressive in nature.

Most disability policies, including MetLife policies, state that the company may waive ongoing proof of loss or medical care requirements if further medical care would be of no benefit to you. However, in practice, absent attorney involvement or a negotiated settlement of the disability claim, most insurers—including MetLife—refuse to permanently waive proof of loss requirements even in claims involving serious medical conditions.

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7. Why does MetLife want to interview me? Should I be concerned that MetLife is sending someone to interview me in-person or at my house instead of asking me questions on the phone?

It is not uncommon for MetLife to require multiple interviews over the course of the claim. MetLife policies specifically state that they can, at their expense, have their representatives conduct telephone or in-person interviews “as often as is reasonably necessary,” and MetLife tends to liberally interpret when an interview is “necessary.”

Sometimes these interviews are part of a regularly scheduled check-in; in other instances, they may be prompted by recent developments, such as you taking on a new job or MetLife acquiring surveillance footage it believes is inconsistent with your reported limitations. Regardless, they are important claim events that must be taken seriously and approached with a prudent degree of preparation.

Some disability companies are more inclined to conduct phone interviews, and this became more common after the COVID pandemic. However, in our experience, prior to the COVID pandemic, MetLife required in-person interviews more often than other insurers, and this has not changed.

MetLife has third-parties (often private investigators and/or interviewers who only work for insurance companies) who conduct in-person interviews on their behalf. The investigators will ask very detailed questions about the nature of your disability, treatments, current symptoms and limitations, as well as questions about your daily activities, any work you are performing, and hobbies.

MetLife interviews are also often much longer and can last several hours, depending on the nature of the underlying claim. In that respect, they are closer to a deposition than a check-in by phone. Though they lack the same formal structure as depositions, MetLife uses field interviews to determine whether to deny claims or terminate benefits, and the implications can be just as significant.

Even if you have been on claim for years, the answers you give will be compared with what you wrote on prior claim forms and what you have said in prior interviews. The investigator will be looking for inconsistencies, so it is important to have the entire timeline of your claim fresh on your mind, not just the most recent developments. The investigator will also be keying in on any statements that may suggest that your condition is improving, as well as gathering information to use for any surveillance that might be conducted.

After the interview, the investigator will typically compile a written report for MetLife, which MetLife will typically claim is proprietary and won’t share the report short of litigation. Having a record of what was said during an interview is invaluable for two reasons—to check for any discrepancies between what you said and what the interviewer reported to MetLife, and to document any questions that went outside the scope of what MetLife is allowed to ask. For this reason, we recommend taking notes for an interview or having an attorney present to make sure all questions are appropriate.

Some of the questions may seem invasive and impertinent to your claim and, while most MetLife policies give broad discretion to investigate the claim, not everything is fair game. An experienced disability attorney can help you navigate an interview, to ensure you don’t jeopardize your claim or provide any information you don’t have to.

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8. Why is MetLife requiring an in-person medical examination or IME? Can I limit the scope of the exam?

Like most disability policies, MetLife policies usually include a provision that allows them to request an in-person medical examination to verify any disabling conditions. While this is common practice in the industry, MetLife’s policies tend to be broader and more all-encompassing when it comes to examinations.

For example, your MetLife policy might not only allow an in-person examination, but also state that the exam “may include x-rays, blood and urine tests, psychological tests, and other tests or procedures that We deem reasonable to evaluate whether You continue to meet the definition of Disability.”  Most MetLife policies also “reserve the right to choose the examiners,” and MetLife typically chooses a doctor that works exclusively for insurance companies and has worked for MetLife before.

This is significant because it puts the nature and scope of the exam in MetLife’s hands and, if you refuse to cooperate, MetLife can deny or terminate your benefits. While this does not necessarily mean they can force you to undergo a procedure that you are not comfortable with, it does make termination/denial of benefits and the need for litigation more likely in that scenario—particularly if the exam is performed by a biased medical examiner.

If you are concerned about whether a MetLife in-person medical exam will be unbiased, an experienced disability attorney can vet the doctor MetLife has selected, and take action to ensure that your claim is handled in an appropriate and fair manner.

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9. Does MetLife conduct surveillance in physician claims?

Yes, MetLife is a company that conducts surveillance, including online and in-person surveillance.

Often, MetLife will start with information you’ve provided during an interview or on claim forms as a starting point for surveillance. MetLife’s goal is to look for evidence (that they may take out of context) that you can do activities that cut against the limitations you have reported. Thus, even if you are not practicing medicine or engaging in your occupation, MetLife will still look for other activities that are arguably inconsistent with your underlying medication conditions and reported pain levels.

In addition to reviewing your verbal and written answers to its questions, MetLife will also typically review your online presence/social media. MetLife may also review the profiles of your dental practice, family members and/or friends on social media, in an attempt to gather more information about you. From there, MetLife moves on to in-person surveillance if they feel that is warranted, given your hobbies and how you present online.

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10. Why is MetLife asking for my personal/dental practice financials? Can I refuse to give them my private information? Should I let them speak with my accountant?

Most MetLife policies contain language stating that they can require “audits” of your business records by a financial examiner of their choice.  More recent MetLife policies expand upon this and can require that the audit include “examination of business and financial records for any business in which You have an ownership interest.”

If your policy contains these or similar provisions, you cannot categorically deny MetLife access to your financial records and expect to be paid.  However, these provisions do have limits and under the language of most MetLife policies, the audits can only be required if they are “reasonably necessary.”

This means that you can object to financial requests, but you must have a specific reason for the objection.  For example, the request might be duplicative of other requests and MetLife may already have sufficient financial information in its claim file to make a claim determination.  Alternatively, the request may be overbroad and encompass financial information that, for example, might be relevant to a partial disability claim but not a total disability claim.

Whatever, the case, if there is disagreement, MetLife will most likely dig in its heels and it may not be possible to resolve the matter without litigation. If you are considering withholding financial information from MetLife, you should first speak with an experienced disability attorney, who can evaluate whether that would be appropriate in your particular circumstances and explain the possible repercussions of doing so.

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11. Why is MetLife’s doctor contacting my treating doctor directly?

When you file your disability claim, MetLife will typically assign a physician’s disability claim to an in-house doctor and pay that doctor to review your medical records and look for any gaps or inconsistencies. Often, MetLife will then direct their doctor to call your treating doctors in what is called a “peer to peer” call. MetLife may tell you this is going to happen, but in most cases, this takes place behind the scenes without your knowledge.

In these calls, MetLife doctors ask questions that are crafted to elicit responses that the company can use to deny or terminate your claim. The best way to prevent this from happening is to have all correspondence with your medical providers be in writing and go through a disability attorney.

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12. Why is MetLife asking for an such broadly worded authorization form to gather my records?

As part of the initial proof of loss packet, MetLife includes an investigative authorization they require you to sign that provides them with ability to not only obtain medical records but also to contact the IRS, Social Security Administration, state taxing authority, any current or former employer, business associate or partners, and insurance companies, among others.

The purpose of these requests is not only to obtain information about your medical disability, but also to establish your employment, employment history, and income, and to allow MetLife access to your medical providers.

This process can feel very invasive and, if you have never experienced it before, it can be hard to tell whether your insurer is taking things too far. If you are unsure whether MetLife is acting appropriately, an experienced disability insurance attorney can help you to assess/limit the scope of any overly broad or improper investigation.

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13. Can I file a disability claim with MetLife if my claim is due to a mental health condition like depression, anxiety or panic attacks?

MetLife policies can limit or exclude recovery for mental health conditions, so it is important to check your policy before filing a disability claim based on a mental health limitation.  If the policy limits recovery, benefits will most likely only be payable for two years/twenty-four months, instead of the entire max benefit period.

These limitations and exclusions are not only in MetLife policies, and can appear in disability policies issued by other insurers.  However, MetLife’s policies often have more detailed and broader lists of what is covered by the exclusion or limitation.  For example, a MetLife policy might state that:

Mental Disorder and/or Substance Use Disorder means any and all disorders set forth in the diagnostic categories of the most recently published edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Examples include, but are not limited to:

  1. Depression/dysthymic disorder;
  2. Obsessive compulsive disorder;
  3. Any psychotic disorder;
  4. Panic disorder/agoraphobia;
  5. Bipolar disorder/cyclothymic disorder;
  6. Anxiety disorder;
  7. Diagnosed personality disorder;
  8. Anorexia nervosa or bulimia;
  9. Alcohol or substance abuse or dependency;
  10. Post-traumatic stress disorder; and
  11. Somatization disorder.

Mental health claims are also the most frequently challenged disability claims, and MetLife can be a difficult insurer to deal with on these claims. Accordingly, if you are planning on filing a disability claim with MetLife for anxiety, depression, or another mental health condition, you should first consult with an experienced disability insurance attorney.

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14. Why is MetLife asking for “objective” medical evidence?  And what if it isn’t available or applicable in my situation?

MetLife will often demand specific “objective” medical evidence of a disabling condition and use the absence of “objective” evidence as a basis to deny or delay benefits, even in situations where it is not usually available (such as for mental health claims and other subjective conditions).

One example is the case of Satterwhite v. MetLife[1]. Satterwhite suffered from several mental health conditions, including depression, OCD, and anxiety. Although she submitted corroborating medical records of her conditions, MetLife denied her claim. MetLife engaged in several tactics that we see insurers use—including cherry-picking from records to argue a return to work is possible and relying on paper reviews only/not requesting independent medical examinations. Further, in its denial, MetLife indicated that there were several other tests that Satterwhite didn’t have, but could have submitted in support of her claim.

The Court took issue with this, stating that MetLife “improperly faulted the plaintiff for failing to provide specific information regarding her disability when MetLife did not ask for those specific types of tests and chose not to conduct these tests itself.”

This case is notable because it highlights that MetLife, at times, improperly shifts certain investigative burdens to the claimant.  It also shows that MetLife is willing to stubbornly stand-by a denied claim for years of litigation and refuse to fairly evaluate claims until a court forces them to do so.

Accordingly, it is very important to properly present your disability claim from the outset—including appropriate medical documentation—to avoid a claim denial and the costs and delays that come with that.

[1] Satterwhite v. Metropolitan Life Ins. Co., No. 1:06-cv-165, 2011 WL 1103429 (E.D. Tenn. Feb. 19, 2011).

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15. I am a physician with neck/back pain and my MetLife policy has a two-year limitation for neuromusculoskeletal disorders. Will I be able to collect?

We’ve seen that some MetLife policies are being issued with a two-year limit on benefits payable for neuromusculoskeletal disorders. This is a new development in the disability industry and can be particularly problematic for physicians with musculoskeletal issues.

These limitations were most likely added to newer policies for that very reason—MetLife determined that it has been paying-out too much money for musculoskeletal conditions and wanted to limit its financial liability going forward.

In most versions of this limitations that we’ve seen so far, there are some exceptions to the limit.  For example, the MetLife policy might state that the limitation doesn’t apply if there is an underlying diagnosis of radiculopathy. However, radiculopathy can be difficult to prove up and, even with the diagnosis, MetLife may seek to challenge eligibility for the exception.

One such example of this is the case of Hennen v. MetLife[1].  Hennen became disabled due to lower back pain and lumbar degenerative disc disease (DDD). As the two-year mark neared, MetLife contacted Hennen’s doctors, and one of her doctors specifically confirmed a diagnosis of radiculopathy. However, MetLife had a nurse-consultant review the file and she indicated that there was a lack of current MRI or electromyography results in Hennen’s file. Then, when Hennen’s treating doctor sent in an MRI and reiterated his diagnosis of lumbar radiculopathy, MetLife’s reviewing family medicine physician disagreed and opined that the MRI did not show compression that would support a diagnosis of lumbar radiculopathy.

On appeal, Hennen submitted EMG testing that also confirmed a diagnosis of radiculopathy. At this point, MetLife’s medical director admitted that the EMG supported a diagnosis of lumbar radiculopathy. However, MetLife then turned to looking for other ways to limit benefits.  Specifically, MetLife began assessing Hennen’s functionality and whether her condition rendered her disabled under the terms of her policy.

They forwarded Hennen’s case to a different doctor. This doctor (not surprisingly) challenged the findings that Hennen had radiculopathy and MetLife then found that Hennen would not avoid the two-year limit on benefits.

Ultimately, Hennen sued and the court ruled in Hennen’s favor.  However, this case illustrates that MetLife intends to aggressively apply these limitation provisions, particularly in the ERISA context.

[1] Hennen v. Metropolitan Life Ins. Co., 904 F.3d 352 (7th Cir. 2018).

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16. I’ve heard that MetLife uses biased doctors. Is this true?

When investigating disability claims, MetLife often asks for a paper review by a doctor, or requests a medical examination of the claimant. MetLife claims that these reviews/exams are “independent,” but in our experience, this is not always the case.

Often, these doctors are in MetLife’s back pocket, and some receive a majority of their income (or even all of their income) from work done for MetLife and other disability insurance companies. Sometimes the doctors have a history of board complaints, and many do not have active clinical practices. Some are even given formal titles by MetLife, such as “Senior Independent Medical Consultant,” and/or receive ongoing training/training modules from MetLife instructing them on how to approach the medical exams and reviews.

Obviously, these doctors have strong incentives to keep MetLife happy, and it is not surprising that they tend to produce reports that favor MetLife’s financial interests.  Depending on the nature of your claim, you may need to get your own medical experts and/or attorneys involved to ensure that your claim is being fairly considered by MetLife’s medical consultants.

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17. Do I need to hire a MetLife disability attorney to file my claim?

While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis—in our experience physician claims are not that straightforward.

Many of our clients have more nuanced conditions, such as slowly progressive musculoskeletal conditions due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a physician or surgeon. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test.

Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies are often costly, stressful, and, in some instances, can drag out over several years, all to the insurance company’s advantage. Even if you prevail, it can be an exhausting process, and companies typically appeal, which can take at least another year or more, all the while you are not getting paid benefits.

In our view, it is more prudent to approach your claim carefully from the outset and have your attorney address any concerns that MetLife may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off, you are not working and your only option is a lawsuit.

In our experience, the most common areas where complexities can arise in physician’s disability claims include:

    • The timing of the claim (particularly in situations where a disabling condition is slowly progressive or the where physician works too long in spite of his/her condition);
    • Claims made by physicians with multiple sources of income, some of which may continue post-disability;
    • Claims made by physicians who have taken an active role in office/hospital administration or are involved in non-clinical work;
    • Claims involving multiple policies with different insurers;
    • Claims initially handled by the physician individually, without legal representation;
    • Claims where the physician has already submitted to an interview under oath or an insurance company medical exam;
    • Claims involving an inadequate medical work-up and/or limited treatment history;
    • Claims involving high benefit amounts, young claimants and potentially permanent conditions;
    • Claims involving conflicting recommendations for or against worksite modifications, certain treatments, procedures and/or surgery;
    • Claims where the underlying condition is difficult to diagnose or is diagnosed by exclusion;
    • Claims involving musculoskeletal conditions; and
    • Claims involving mental health conditions.

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18. When should I contact an attorney about my MetLife disability claim?

Physicians who are considering filing a claim for disability insurance benefits should meet with a disability attorney well-before submitting a claim.

Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Before filing, physicians should make a coordinated effort, with an attorney’s assistance, to determine whether their particular claim is covered, and if so, how that claim is best presented to ensure payment.

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The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.

Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. If you are a physician concerned that MetLife is not handling your claim fairly, an experienced disability insurance attorney can help you assess the situation and determine what options are available to you.

Notable MetLife Disability Insurance Cases

Syed v. Metro. Life Ins. Co., No. 3:21-CV-1098-BEN-JLB (S.D. Cal. July 14, 2022).

Schmill v. Metro. Life Ins. Co., No. CV 21-1470 (E.D. La. July 11, 2022).

Metro. Life Ins. Co. v. Liebowitz, No. 2:20-CV-276-JES-MRM (M.D. Fla. Mar. 21, 2022).

Mathis v. Metro. Life Ins. Co., No. 118CV01893JRSDLP (S.D. Ind. Feb. 4, 2020).

Mathis v. MetLife, No. 1:18-cv-01893-JRS-DLP (S.D. Ind. March 28, 2019).

Dowdy v. Metropolitan Life Insurance Company, 890 F.3d 802 (9th Cir. 2018).

Hennen v. Metro. Life Ins. Co., 904 F.3d 532, 534 (7th Cir. 2018).

Metro. Life Ins. Co. v. Oyedele, No. 12-CV-04607-JD (N.D. Cal. Dec. 10, 2014).

Allen v. MetLife, No. 4:06-CV-175-H (E.D.N.C. March 31, 2008).

Sutton v. Metro. Life Ins. Co., No. 220CV00698KJMCKD  (E.D. Cal. June 16, 2022).

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Why You Should Read Your Policy Carefully: a Case Study

Insurance Company Tactics: Conducting Multiple Paper Reviews

Study Shows Increase in Long Term Disability Claim Denials

Litigation Against Insurers – Attorneys’ Fees

Understanding Your Policy: Maximum Benefit Period

Understanding Residual Disability Benefits: Are They Worth the Cost?

Authorization Forms: What Information Are You Releasing to Your Disability Insurer?

Insurer Profiles #7: MetLife

Disability Insurer Profiles: MetLife

MetLife to Exit Individual Disability Insurance Market