MetLife denial letters are not the end of the process

When MetLife denies a disability claim, you have options beyond accepting the decision. MetLife is a private insurance company, not Social Security, so the rules for challenging their "no" are different from SSDI appeals. You can request that MetLife reconsider, file a formal appeal through their internal process, or work with an attorney who handles insurance disputes.

The path you choose depends on why MetLife said no. Some denials rest on a misunderstanding of your medical records. Others turn on how MetLife interprets the definition of disability in your policy. An attorney who has handled MetLife cases before knows which arguments work and which ones MetLife has already rejected a hundred times.

Key Takeaways

  • MetLife denials can be challenged through their internal appeal process, which is separate from Social Security and has its own important date and rules.
  • An attorney who specializes in insurance disputes can review your denial letter to identify whether MetLife misread your medical evidence or misapplied your policy language.
  • You typically have 180 days from the denial letter to file an appeal with MetLife, though your policy may set a different window.
  • If MetLife's internal appeal also fails, you may have the right to sue in court, but this requires an attorney and depends on what your policy says.

Why MetLife denies disability claims

MetLife denies claims for a handful of recurring reasons. The most common is that MetLife concludes your condition does not meet the definition of disability stated in your policy. That definition is often narrower than what Social Security uses—many MetLife policies require that you be unable to perform the duties of your own occupation, not just any work.

A second frequent reason is insufficient medical evidence. MetLife may say your doctors did not provide enough detail about your functional limitations, or that the records do not support the severity you claim. A third is that MetLife believes you do not meet the elimination period—the waiting time before benefits begin—or that you returned to work and therefore are no longer disabled.

Some denials rest on policy exclusions. If your policy excludes mental health conditions, or conditions that existed before you enrolled, MetLife will cite that exclusion. Others turn on whether MetLife thinks you disclosed a pre-existing condition when you bought the policy.

The MetLife appeal process and your timeline

MetLife's internal appeal is not optional if you want to preserve your right to sue later. Most policies require you to exhaust MetLife's internal review before going to court. You typically have 180 days from the denial letter to request an appeal, though check your actual policy document because some plans set a shorter window.

When you appeal, you can submit new medical records, new statements from your doctors, or new evidence that MetLife overlooked the first time. Many people strengthen their appeal by having their treating physician write a detailed letter explaining why the MetLife definition of disability applies to them. This letter should address the specific language in your policy, not just describe your condition in general terms.

MetLife is required by federal law (ERISA, the Employee Retirement Income Security Act) to make a decision on your appeal within a set timeframe—usually 60 days for disability claims, though urgent cases may be faster. MetLife must provide a written decision that explains which parts of your claim it accepted or rejected and why.

When an attorney becomes necessary

You do not need an attorney to request an appeal from MetLife. Many people write their own appeal letters and gather their own medical records. But an attorney becomes valuable at several points.

First, an attorney can read your denial letter and your policy side by side and tell you whether MetLife made a legal error—whether they misapplied the policy language, ignored medical evidence, or contradicted their own prior decisions. Second, an attorney knows what MetLife's medical reviewers typically look for and can help your doctors frame their statements in language that addresses MetLife's specific objections. Third, if MetLife denies your appeal, an attorney can advise you on whether you have grounds to sue and what that lawsuit would cost and take.

Many disability attorneys work on contingency for MetLife cases, meaning they take a percentage of what you recover if you win, and you pay nothing upfront. This is common enough that you should ask about it when you call.

What an attorney will review in your case

A disability attorney will start by obtaining a complete copy of your policy and your claim file from MetLife. The claim file includes everything MetLife reviewed when they made their decision: your process, your medical records, any statements from your doctors, and MetLife's internal notes about why they said no.

The attorney will then compare what MetLife says you submitted against what actually appears in the file. Denials sometimes rest on the claim that you did not provide certain records, when in fact you did and MetLife misfiled them. The attorney will also check whether MetLife's medical reviewer actually read your records or straightforward skimmed them, and whether MetLife's interpretation of your policy matches how they have interpreted similar policies for other claimants.

Finally, the attorney will assess your medical evidence against the policy definition of disability. If your policy says you must be unable to perform your own occupation, the attorney will look at what your occupation actually required and whether your condition prevents you from doing those specific tasks.

The difference between MetLife appeals and Social Security appeals

MetLife denial appeals and SSDI appeals follow completely different rules. MetLife is governed by ERISA, a federal law that sets strict timelines and procedural requirements but also limits what you can recover—usually just the benefits MetLife wrongly denied, plus interest. SSDI appeals go through the Social Security Administration and can take years, but if you win, the benefits are retroactive to when you first became disabled.

You can pursue both at the same time. Many people appeal a MetLife denial while also filing for SSDI or while their SSDI case is pending. Winning one does not affect the other, though if you receive SSDI benefits, MetLife may reduce your MetLife benefits by the amount of your SSDI payment (this is called an offset, and your policy should explain whether it applies).

Finding an attorney who handles MetLife cases

Not all disability attorneys handle insurance disputes. Some focus only on Social Security. When you search, look for attorneys or firms that specifically list MetLife, long-term disability insurance, or ERISA claims. Your state bar association may have a referral service that filters by practice area.

When you call, ask whether the attorney has handled MetLife denials before, how many, and what the outcomes were. Ask whether they work on contingency and what percentage they take. Ask what they charge for an initial consultation—many offer free consultations, but some charge a flat fee. Ask how long they think your case will take and what the next steps are if MetLife denies your appeal again.

You can also contact your state's insurance commissioner's office. They do not handle individual claims, but they can tell you whether MetLife has a pattern of wrongful denials and may have educational materials about your rights.

Frequently Asked Questions

Can I appeal a MetLife denial on my own, or do I need a lawyer?

You can appeal on your own. Many people do. But an attorney can identify legal errors in MetLife's reasoning and help you present medical evidence in the way MetLife's reviewers are most likely to understand. If you lose the appeal and want to sue, you will almost certainly need an attorney then.

How long does a MetLife appeal take?

MetLife has 60 days to decide your appeal, though they may ask for more time if they need additional medical records. In practice, appeals often take longer because you may need time to gather new evidence from your doctors before you even submit the appeal.

What happens if MetLife denies my appeal?

You can sue MetLife in federal court if your policy allows it. This requires an attorney and can take years. Some policies limit what you can recover to the benefits MetLife wrongly denied; others allow you to sue for additional damages. Your attorney will review your policy to see what your options are.

Does winning a MetLife appeal affect my Social Security disability case?

No. MetLife and Social Security are separate systems. Winning one does not change the other. However, if you receive SSDI benefits, MetLife may reduce your MetLife payment by the amount of your SSDI benefit, depending on what your policy says.

How much does it cost to hire an attorney for a MetLife appeal?

Many attorneys work on contingency, taking a percentage of what you recover if you win and charging nothing upfront. Others charge an hourly rate or a flat fee. Ask about this when you call. Contingency arrangements are common enough that you should not hire someone who will not discuss it.