What happens when MetLife denies your claim
When MetLife denies a disability claim, you receive a written decision letter that explains why. The letter includes the reason for denial, what documents MetLife reviewed, and your right to appeal. You have a set window to request an appeal — usually 180 days from the date of the denial letter, though your policy may specify a different timeframe. Check your denial letter for the exact important date.
The appeal process is separate from the original claim review. MetLife will assign a different reviewer to examine your case again, and you can submit new medical evidence, statements from your doctor, or other documentation that was not in the original file. This is your chance to address the specific reason MetLife gave for the denial.
Key Takeaways
- You have 180 days (or the period stated in your policy) from the denial letter to request an appeal in writing.
- Send your appeal request and any new evidence directly to the address listed in your denial letter, not to a general customer service line.
- MetLife will assign a new reviewer who has not seen your case before and must make a decision within 45 days of receiving your complete appeal.
- Medical evidence from your treating doctor that addresses MetLife's stated reason for denial is the strongest material you can include.
- If MetLife denies your appeal, you may have the right to pursue further review through your state's insurance commissioner or through legal action.
Gather the documents MetLife needs to reconsider
Before you write your appeal letter, collect the medical records and statements that directly address why MetLife denied you. If MetLife said your condition does not meet the policy definition of disability, get a letter from your doctor explaining how your condition prevents you from working. If MetLife said you did not provide enough medical evidence, request all treatment records from your doctors since the date you stopped working.
The strongest evidence is a detailed statement from your treating physician — the doctor who knows your condition best — rather than a general medical record. Ask your doctor to write a letter that specifically addresses MetLife's reason for denial. For example, if MetLife said your condition is not severe enough to prevent work, ask your doctor to explain why you cannot perform your job duties. Provide this letter along with any recent test results, imaging, or specialist reports that support your claim.
Also gather any documents that show you have tried to work or return to work and could not. This includes emails from employers, notes about job searches you attempted, or records of rehabilitation efforts. If your condition has worsened since the original claim, include new medical evidence showing that change.
Write and submit your appeal request
Your appeal must be in writing. Start with a clear statement that you are requesting an appeal of your claim denial. Include your policy number, the date of the denial letter, and a brief explanation of why you believe MetLife made an error. Then address the specific reason MetLife gave for the denial — do not argue in general terms.
Keep your letter focused and factual. If MetLife said your condition does not prevent you from working, explain in your own words why you cannot work, then attach your doctor's letter that says the same thing. If MetLife said you did not submit enough medical records, list the new records you are now providing. Do not repeat arguments from your original claim unless you have new evidence to support them.
Send your appeal letter and all supporting documents to the address listed in your denial letter under "Appeals" or "How to Appeal." Do not send it to the general claims address or customer service. Keep a copy of everything you send, and consider using certified mail with return receipt so you have proof MetLife received it. Include a cover page that lists all documents you are submitting.
What MetLife does during the appeal review
Once MetLife receives your appeal, a different reviewer — someone who did not handle your original claim — will examine your case. This reviewer must look at your original claim file plus any new evidence you submitted. MetLife has 45 days from the date it receives your complete appeal to make a decision and send you a written response.
The reviewer will check whether your condition meets the definition of disability in your policy, whether you provided sufficient medical evidence, and whether you meet any other requirements listed in your policy. The reviewer may request additional information from your doctors or may contact your employer. You do not attend a hearing or speak to the reviewer during this process unless your policy or state law requires it.
MetLife must send you a written decision that explains what it found, what documents it reviewed, and why it upheld or overturned the denial. If MetLife overturns the denial, it will tell you when benefits will begin and how much you will receive. If MetLife upholds the denial, the letter will explain your next options.
Timeline and what to expect at each stage
| Stage | What Happens | Your Timeframe | MetLife's Timeframe |
|---|---|---|---|
| Receive denial letter | MetLife explains why it denied your claim and tells you how to appeal | Review the letter and note the appeal important date | Already completed |
| Gather evidence | You collect medical records, doctor letters, and other supporting documents | Complete before submitting appeal (no set important date, but sooner is better) | Not applicable |
| Submit appeal | You send your appeal letter and documents to MetLife's appeals address | Must submit within 180 days of denial letter (check your policy for exact important date) | Not applicable |
| Appeal review | A new MetLife reviewer examines your case and all evidence | Wait for decision | 45 days from receipt of complete appeal |
| Receive appeal decision | MetLife sends written decision approving or denying your appeal | Review decision and plan next steps if needed | Already completed |
What to do if MetLife denies your appeal
If MetLife denies your appeal, you have options beyond MetLife's internal process. First, check your policy and your denial letter to see whether you have the right to request an external review. Some policies allow you to ask an independent reviewer outside MetLife to examine the case. This is different from MetLife's internal appeal and may have a separate important date.
You can also file a complaint with your state's insurance commissioner or department of insurance. This office investigates complaints about insurance companies and can pressure MetLife to reconsider if it finds the company did not follow its own policy or state law. Contact your state insurance commissioner's office for the complaint process and any forms required.
If you believe MetLife wrongfully denied your claim, you may have grounds to pursue a lawsuit. This is a significant step and usually requires consulting an attorney who handles disability insurance disputes. An attorney can review your case, your policy, and MetLife's decision to determine whether you have a legal claim. Some attorneys work on contingency, meaning they take a percentage of any settlement or judgment rather than charging upfront fees.
Common reasons MetLife denies appeals and how to address them
Insufficient medical evidence: MetLife says your medical records do not prove you cannot work. Response: Get a detailed letter from your treating doctor that specifically states you cannot perform your job duties and explains why. Include recent test results or specialist reports that support the diagnosis.
Condition does not meet policy definition: MetLife says your condition, even if real, does not prevent you from working under the policy's terms. Response: Ask your doctor to address the specific language in your policy definition. If your policy requires you to be unable to perform "any occupation," have your doctor explain why you cannot do any job, not just your own job.
Pre-existing condition exclusion: MetLife says your condition existed before your coverage began and is excluded. Response: If you were not diagnosed or treated for the condition before coverage started, provide medical records showing the condition is new. If you were treated before, ask your doctor whether the current disability is a new development or worsening of the old condition.
Failure to meet waiting period: MetLife says you did not wait the required number of days after stopping work before filing. Response: Check your policy for the exact waiting period requirement. If you filed too early, you may need to wait and resubmit, or ask MetLife whether you can amend your claim date.
Frequently Asked Questions
How long do I have to appeal after MetLife denies my claim?
Most MetLife policies give you 180 days from the date of the denial letter to request an appeal. Your specific important date is stated in the denial letter and in your policy document. If you are unsure, call MetLife and ask for the exact appeal important date for your policy.
Can I submit new medical evidence during the appeal that I did not include in the original claim?
Yes. The appeal process is designed to let you provide additional evidence. New medical records, updated doctor letters, or test results completed after your original claim are all acceptable. This is one reason appeals often succeed — you have a second chance to build your case.
Will I talk to someone at MetLife during the appeal process?
Not usually. MetLife's appeal is a paper review — a different reviewer reads your written appeal and documents and makes a decision. You do not attend a hearing or speak to the reviewer unless your policy or state law requires it. Some states do require a hearing; check your state's insurance rules or ask MetLife.
What happens if MetLife approves my appeal?
MetLife will send you a written approval letter stating the amount of your monthly benefit and when payments will begin. Back pay may be included if the approval covers the time between your original denial and the appeal approval. MetLife will explain the payment schedule in the approval letter.
Can I hire a lawyer to help with my appeal?
Yes. An attorney who handles disability insurance claims can review your case, help you gather evidence, and write your appeal letter. Some attorneys charge hourly fees; others work on contingency and take a percentage of any money you recover. Consult with an attorney before spending significant time on the appeal if the claim amount is large.