MetLife Disability Claim Denied: How to Appeal and Win

MetLife is one of the largest group disability insurers in the United States, administering long-term and short-term disability benefits for millions of employees. When MetLife denies a disability claim, claimants often find themselves facing a sophisticated claims operation with in-house medical reviewers, vocational analysts, and claim handlers trained to protect the company's bottom line. Understanding how MetLife's denial process works — and how to counter it — is the key to a successful appeal.

Why MetLife Denies Disability Claims

MetLife's denial tactics are well-documented in litigation and disability law practice. The most common reasons MetLife denies claims include:

Vocational analysis findings. MetLife employs vocational analysts who review your education, work history, and assessed functional capacity to identify jobs they believe you can perform. This analysis is particularly important at the 24-month own-occupation to any-occupation definition shift. MetLife's vocational analysts may rely on outdated Dictionary of Occupational Titles (DOT) data, fail to account for your specific limitations, or identify jobs that exist only in theory for someone with your medical restrictions.

Conflicting physician opinions. MetLife uses its own in-house medical reviewers — physicians and nurses who review your file without examining you. When MetLife's reviewer disagrees with your treating physician, MetLife typically sides with its own reviewer, citing its authority as plan administrator to weigh conflicting medical opinions. However, as the Supreme Court recognized in MetLife v. Glenn (2008), MetLife operates under a structural conflict of interest as both the decision-maker and the entity that pays benefits.

Insufficient functional limitation documentation. MetLife frequently claims that while a claimant has a diagnosis, there is not enough documentation of how that diagnosis translates into specific functional limitations that prevent work. Your diagnosis alone — even a severe one — is not enough. You must document what you cannot do and why.

The own-occupation to any-occupation transition. At 24 months, MetLife reviews whether you can perform any occupation, not just your prior job. Many claimants who were approved under the own-occ definition face termination at this transition because MetLife's vocational analyst identifies sedentary jobs you theoretically could perform.

Surveillance evidence. Like other major disability insurers, MetLife uses private investigators to conduct video surveillance. Brief video clips showing physical activity are used to challenge claimed limitations.

The MetLife v. Glenn Case and Your Rights

The Supreme Court's 2008 decision in MetLife v. Glenn arose from MetLife's denial of disability benefits to Wanda Glenn, a MetLife plan administrator. The Court held unanimously that when an ERISA plan gives the plan administrator discretion to determine eligibility, and that same entity both evaluates claims and pays benefits from its own assets, a structural conflict of interest exists. Courts must weigh this conflict when reviewing MetLife's benefit decisions.

What this means for you: MetLife's conflict of interest — it saves money by denying your claim — is a legally recognized factor. Courts applying this precedent have overturned MetLife denials where the conflict of interest, combined with other procedural and substantive flaws, rendered MetLife's decision unreasonable.

Building Your MetLife Appeal

Get Your Claim File First

Request your complete claim file from MetLife in writing within 30 days of your denial. MetLife must provide the file free of charge. Review it carefully for:

• The opinions of MetLife's reviewing physicians and the basis for their conclusions
• Any vocational analysis reports — check the jobs identified against your actual functional limitations
• Surveillance records and summaries
• Internal claim handler notes

Strengthen Your Medical Evidence

The core of your appeal is medical evidence that specifically documents functional limitations:

• Treating physician RFC assessment: A detailed form completed by your doctor specifying how many hours you can sit, stand, walk, and your ability to concentrate, remember, and sustain effort. Generic letters are insufficient.
• Specialist evaluations: Cardiologist, neurologist, psychiatrist, rheumatologist, or other relevant specialist documentation.
• Objective findings: Lab results, imaging, EMG/nerve conduction studies, echocardiograms, neuropsychological testing.
• SSDI award: If you have been awarded Social Security Disability, the SSA's finding of disability is relevant and must be addressed by MetLife.

Counter the Vocational Analysis

If MetLife's denial relied on a vocational analysis, obtain an independent vocational expert opinion. An independent vocational expert can review the jobs MetLife identified and demonstrate that:

• The jobs require capacities you do not have
• The jobs are not available in sufficient numbers in your regional economy
• Given your specific medical restrictions, no competitive employment is actually available to you

Address the Conflict of Interest

In your appeal letter, explicitly note MetLife's structural conflict of interest under Glenn. State that you expect a thorough, unbiased review that weighs your treating physician's opinion appropriately and that any new evidence generated during the appeal will be provided to you for response before a final decision, as required under the 2016 DOL claims procedure regulations.

ERISA Rights and Deadlines

If your MetLife policy is employer-sponsored, ERISA governs your appeal:

• 180 days to appeal from the date of MetLife's denial letter
• Right to claim file at no charge
• New evidence rule: MetLife must share any new evidence or rationale developed during appeal review before issuing a final decision (2016 DOL regulations)
• Right to sue under § 502(a) after exhausting internal appeals
• Right to External Independent Review: Complete Guide" class="auto-link">external review in many states

MetLife Disability Appeals: MetLife Disability P.O. Box 14590 Lexington, KY 40512

Send all correspondence via certified mail with return receipt.

Fight Back With ClaimBack

MetLife's disability claim process is designed to be opaque and discouraging. ClaimBack cuts through the complexity and helps you build a compelling, evidence-based appeal.

Start your MetLife disability appeal now

Related Reading

• How to Write an Insurance Appeal Letter
• Internal vs. External Insurance Appeal
• Common Reasons Insurance Claims Are Denied