MetLife's most common reasons for denial, and what they mean

MetLife denies disability claims for a small number of specific reasons, and understanding which one appears in your denial letter matters because each one requires a different response. The most frequent denials fall into three categories: insufficient medical evidence that your condition prevents you from working, a gap between when your disability began and when you filed your claim, or a information that your condition does not meet the definition of disability in your policy.

MetLife's definition of disability typically requires that you cannot perform the duties of your own occupation (if you are in the first two years of disability) or any occupation for which you are reasonably suited by education, training, or experience (after two years). This is narrower than Social Security's definition. A condition that qualifies for SSDI may still fall short of MetLife's standard, especially in the first 24 months when MetLife focuses on your specific job rather than work in general.

The second major category is timing. If you stopped working in March but did not file your claim until September, MetLife may deny the claim on the grounds that you did not report the disability promptly. Most policies require notice within 30 to 90 days of the onset of disability, though the exact window depends on your plan. A late filing does not always mean permanent denial, but it shifts the burden of proof onto you to show that the delay was reasonable.

Key Takeaways

  • MetLife denies most claims because the medical records do not show that your condition prevents you from working in your own job (first 24 months) or any job you could reasonably do (after 24 months).
  • A denial letter will cite the specific policy language and the reason MetLife applied it; read the letter carefully to see whether the issue is medical evidence, timing, or the definition of disability itself.
  • You have the right to request an internal review within 180 days of the denial, and you can submit new medical records, statements from your doctors, and written arguments about why you disagree with MetLife's decision.
  • If MetLife denies your internal review, you can file a complaint with your state's insurance commissioner and pursue external review or legal action, though the cost and timeline vary by state.
  • Gathering detailed medical records, a statement from your treating physician about your functional limitations, and documentation of your job duties before you file will strengthen any appeal.

How to read your MetLife denial letter

Your denial letter contains three essential pieces of information: the specific reason MetLife gave for the denial, the policy language it cited, and the important date for you to request an internal review. Read the letter twice—once to understand the outcome, and once to identify exactly what MetLife says is missing or wrong.

If MetLife says "insufficient medical evidence," the letter should specify what evidence is missing. Common gaps include no recent imaging or test results, no statement from your treating doctor about your functional limitations, no documentation of treatment attempts, or no clear connection between your diagnosis and your inability to work. If the letter says your condition "does not meet the definition of disability," MetLife is saying that even with the medical records you provided, the condition does not prevent you from performing your job or other work. If the letter cites a "failure to provide notice," MetLife is saying you waited too long to file.

The denial letter will also state the important date for requesting an internal review, usually 180 days from the date of the letter. This important date is firm. If you miss it, you lose the right to an internal review and must pursue other remedies through your state insurance commissioner or the courts.

Requesting an internal review of MetLife's decision

An internal review is MetLife's own reconsideration process. You submit new information, written arguments, or both, and a different MetLife reviewer examines your claim from the beginning. The internal review is free and does not require a lawyer, though you can hire one if you choose.

To request an internal review, contact MetLife's claims department and ask for the internal review process. You can do this by phone, email, or certified mail—certified mail creates a paper trail and is often the safest choice. MetLife will send you a form or instructions. You then have a window (usually 30 to 60 days) to submit your materials.

What to include in your internal review submission: a written statement explaining why you disagree with the denial, new medical records or test results if you have them since the original claim, a detailed statement from your treating physician describing your functional limitations and why you cannot perform your job duties, documentation of any treatment you have undergone since the original claim, and a description of your job duties before you became disabled. If the denial was based on timing, include evidence that the delay was reasonable—for example, a letter from your doctor explaining why you could not file sooner, or documentation that you were hospitalized or incapacitated.

MetLife typically issues a decision on the internal review within 30 to 60 days. If MetLife upholds the denial, you can then pursue a complaint with your state insurance commissioner or, in some states, external review or legal action.

When to involve your state insurance commissioner

If MetLife denies your internal review, you can file a complaint with your state's Department of Insurance (the name varies by state—some call it the Insurance Commissioner, others the Division of Insurance). This is a free process and does not require a lawyer. The insurance commissioner's office will investigate whether MetLife followed state law and its own policy in making the denial.

To file a complaint, contact your state insurance commissioner's office and ask for the complaint form. You will need to provide a copy of your denial letter, your internal review request and MetLife's response, and a written explanation of why you believe MetLife acted wrongly. The insurance commissioner will forward your complaint to MetLife, which will have a set period (usually 30 to 45 days) to respond. The commissioner's office will then review both sides and issue a finding.

An insurance commissioner's finding does not overturn MetLife's decision directly, but it can pressure MetLife to reconsider, and it creates a record that may be useful if you later pursue legal action. Some states also offer external review, a process in which an independent medical reviewer examines your claim. External review is usually available only if you have already completed MetLife's internal review and meet certain criteria (such as a claim involving a medical judgment call). Check your state's insurance commissioner website for external review rules.

Gathering medical evidence for your appeal

The single most common reason MetLife upholds a denial on internal review is that the medical records do not clearly show you cannot work. This is fixable. Before you submit your internal review, contact your treating physicians and ask them to write a detailed statement about your functional limitations.

The statement should include: a description of your diagnosis and how it affects your body or mind, specific functional limitations (for example, "cannot sit for more than 30 minutes without severe pain," "cannot concentrate for more than one hour," "cannot lift more than 10 pounds"), how long these limitations are expected to last, what treatments you have tried and their results, and a clear statement about whether you can perform your job duties. If your job involves sitting at a desk, the doctor should address whether you can sit; if it involves standing or walking, the doctor should address mobility; if it involves decision-making or customer interaction, the doctor should address cognitive or emotional function.

If you have not seen a doctor recently, schedule an appointment before you submit your internal review. A recent medical record carries more weight than an old one. If cost is a barrier, ask whether your doctor offers a reduced fee for a brief visit focused on a disability statement, or whether a community health center can help. Some disability advocates and legal aid offices also help people obtain medical statements at low or no cost.

Understanding MetLife's two-year transition and its effect on appeals

MetLife's definition of disability changes after 24 months. In the first two years, you must show you cannot perform your own occupation. After two years, you must show you cannot perform any occupation for which you are reasonably suited. This transition can work in your favor on appeal if you are past the 24-month mark, because the standard becomes broader.

If you are appealing a denial that was issued before your 24-month anniversary, and you are now past that date, mention this in your internal review submission. Explain that your claim should now be evaluated under the "any occupation" standard rather than the "own occupation" standard. Provide medical evidence that, even if you could theoretically perform some other work, your condition prevents you from doing so. For example, if you were a surgeon and your tremor prevents you from performing surgery, you might still be able to do desk work—but if your tremor also prevents you from typing or using a mouse, you cannot perform any occupation.

When to consider hiring a disability attorney

You do not need a lawyer to request an internal review or file a complaint with your state insurance commissioner. However, a lawyer becomes useful if MetLife denies your internal review and you want to pursue external review, file a lawsuit, or negotiate a settlement. Disability attorneys typically work on contingency, meaning they take a percentage of any money you recover rather than charging an upfront fee.

Before you hire a lawyer, ask whether they have experience with MetLife claims specifically and with your state's insurance laws. Some attorneys specialize in group disability insurance (the kind provided through an employer), while others focus on individual policies. The wrong specialist may not know the relevant law. Many disability attorneys offer a free initial consultation; use it to ask whether they think your case has merit and what they would charge.

A lawyer can also help you understand whether you have grounds for a bad-faith claim—a legal theory that MetLife denied your claim unreasonably or dishonestly. Bad-faith claims can result in damages beyond the disability benefits themselves, but they are difficult to prove and require strong evidence that MetLife acted in bad faith rather than straightforward making a judgment call you disagree with.

Frequently Asked Questions

Can I work part-time while appealing a MetLife denial?

Yes, but be careful. If you work part-time and earn income, MetLife may argue that you are not disabled under its definition. Report any work or income to MetLife in writing. If you do return to work during the appeal, tell your lawyer or the person handling your appeal when ready, because it may affect the outcome.

How long does an internal review usually take?

MetLife typically issues a decision within 30 to 60 days of receiving your complete submission. The timeline can be longer if MetLife requests additional medical records from your doctors. Ask MetLife for a timeline when you submit your request.

What if MetLife says I did not report my disability in time?

You can still appeal. In your internal review submission, explain why the delay occurred. If you were hospitalized, incapacitated, or did not realize you were disabled until later, provide evidence. Some policies allow for reasonable delays; the question is whether your delay was reasonable under the circumstances.

Can I appeal a MetLife denial more than once?

You have one internal review as a matter of right. After that, your options are an insurance commissioner complaint, external review (if your state offers it), or legal action. You cannot straightforward resubmit the same claim to MetLife and ask for another internal review.

What happens if I win my appeal?

If MetLife overturns the denial on internal review, MetLife will begin paying your benefits retroactively to the date you became disabled (or the date you filed, depending on your policy). MetLife will also pay any back benefits owed. Ask MetLife for a written explanation of the payment schedule and the total amount owed.