MetLife
MetLife
Bartolic Law helped many clients get claims paid by MetLife. We helped a former management consultant suffering from Fibromyalgia demonstrate a physical disability, avoiding MetLife imposing a 24-month limitation on mental health disabilities. In one accidental death insurance case, a client’s family member died of a cocaine overdose, and MetLife declared it was not an accident. With photos and videos, we showed the insured laid out work clothes for the next morning, set an alarm clock, and even pre-packed meals to take to work. We persuaded MetLife the overdose must have been accidental given the intention to go to work the next morning. In a Fentanyl overdose case where nobody knew how the insured ingested the drug, we used visual evidence to prove the insured must have ingested the drug orally, due to lack of any trace of intravenous or transdermal administration. Following up on a witness statement the insured complained of a headache hours before the death, we tracked down an Aspirin bottle with Fentanyl tablets inside, which we used pictures to show the two tablets look nearly identical, resulting in presumptive accidental ingestion. Result: claim paid.
Metropolitan Life Insurance Company
MetLife is one of the biggest insurers of long-term disability and life insurance / accidental death insurance. MetLife issues individual disability insurance policies, as well as group long term disability policies, enforced under ERISA § 502(a). MetLife’s individual disability insurance policies are popular with doctors, lawyers, and dentists, either as stand-alone policies, or to supplement the ERISA-governed group long-term disability policy. Often, the monthly maximums on group policies are insufficient to cover enough of the insured’s income, so the insured buys an additional individual disability insurance policy from MetLife. MetLife frequently denies high value individual disability insurance claims, and group long-term disability claims when the disability definition changes to Any Occupation.
In a long-term disability case, MetLife contended our client could transition to a sedentary job at the Any Occupation stage, ignoring his co-morbid obesity resulting from the spine disorder. We took photos and videos showing the client’s bedsores from limited mobility, and use of a walker to move about the house.
MetLife aggressively denies accidental death insurance claims, claiming the death was not accidental, or that an exclusion applies. In one instance, we found in MetLife’s file notation that a denial would only be defendable if a deferential standard of review applied, as the policy lacked a drug overdose exclusion. Upon highlighting this, MetLife paid the claim.
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