When a disabling injury or illness prevents someone from working, long-term disability (LTD) benefits are often a critical lifeline. Unfortunately, insurance companies like MetLife frequently deny legitimate claims, leaving individuals unsure of their next steps. Understanding how the appeal process works is essential for protecting your rights and ensuring that you receive the benefits you deserve.

Why MetLife Denies Disability Claims

MetLife, like many large insurers, reviews claims using strict definitions of disability and often relies on policy language that is difficult for the average person to interpret. Common reasons for denial include:

  • Insufficient medical evidence – If medical records do not clearly document functional limitations, MetLife may argue that you are still capable of working.

  • Surveillance or social media – Insurers sometimes use surveillance or online activity to claim a person is not as disabled as reported. The Council for Disability Awareness notes that insurers often look for inconsistencies between reported symptoms and observed behavior.

  • Policy definitions – Many MetLife policies switch from an “own occupation” definition to an “any occupation” standard after 24 months, making it harder to continue receiving benefits.

  • Missed deadlines – Strict ERISA timeframes mean even small filing errors can result in claim denial.

According to the U.S. Department of Labor’s ERISA guidelines (dol.gov), insurers must provide clear reasons for denial and give claimants a fair chance to appeal. However, fairness in theory doesn’t always translate into fairness in practice.

How the Appeal Process Works

If MetLife denies your claim, you have the right to appeal—but the process is highly technical and time-sensitive. Under ERISA, you typically have 180 days to submit an appeal. That window is your one opportunity to present additional evidence, because courts often limit review to the administrative record developed during the appeal stage.

Steps generally include:

  1. Review the denial letter carefully
    MetLife must state the specific reasons for denial. Understanding their rationale is key to crafting an effective appeal.

  2. Gather strong medical evidence
    Detailed physician statements, test results, and treatment histories can be critical. Consider asking your doctor to complete a Residual Functional Capacity (RFC) assessment, which outlines your specific physical or cognitive limitations.

  3. Submit vocational evidence
    If your disability prevents you from performing your own occupation or any occupation, vocational experts can provide persuasive reports supporting your claim.

  4. Address policy definitions head-on
    If your plan shifts from “own occupation” to “any occupation,” your appeal must demonstrate why you cannot reasonably perform any job for which you are qualified.

  5. Meet all deadlines and requirements
    ERISA deadlines are unforgiving. Late or incomplete submissions almost always result in dismissal.

The American Bar Association stresses that claimants often underestimate the complexity of ERISA appeals and benefit significantly from legal guidance.

Why Legal Representation Matters

While claimants may attempt to handle appeals on their own, the odds of success improve when an attorney familiar with MetLife’s tactics is involved. Experienced lawyers understand how to:

  • Identify weaknesses in the insurer’s reasoning.

  • Gather and present evidence in the format MetLife is most likely to accept.

  • Preserve the administrative record for potential litigation.

  • Navigate interactions with MetLife’s claims adjusters and medical reviewers.

A GAO study on private disability insurance highlighted that claimants often face significant disadvantages when challenging denials, given insurers’ access to medical consultants and legal teams. Legal representation helps level the playing field.

Moving Forward After a Denial

Receiving a denial letter from MetLife can be discouraging, but it does not mean your claim is over. With a timely and well-supported appeal, many claimants are able to reverse MetLife’s decision and secure the benefits they need.

If you or a loved one has received a denial, the key is not to delay. Start gathering medical documentation, consult with specialists, and strongly consider contacting an experienced attorney to guide the process. The stakes are too high to navigate alone.

For individuals facing these challenges, working with seasoned legal counsel can make the difference between continued financial hardship and the security that disability benefits provide. This is where firms such as Darras Law can step in and provide critical support with a Metlife disability appeal.