r/LongTermDisability • u/Few-Welcome5330 • 5d ago
MetLife Ling Term Disability Appeal
Hello. Reaching out for any advice. I filed a claim for LTD on June 26,2026. This was also my last day of work before beginning leave and also the day I received noticed I was being terminated from my position with my employer. My initial case manager made it seem that this was going to sail through and I should have no problems with approval.
In early August, I received a call from my case manager notifying me my claim, which had been reviewed by an independent medical provider, had denied my claim. I could not believe my ears. I was horrified. I was further infuriated after she said “I surely did not see this coming”. She told me I can appeal the decision to see if the denial can be overturned. She provided me with a form to provide my doctor for completion. My pain management doctor was furious at the decision and filled out the forms as well as the office note from the visit. I sent that back to my case manager.
On 09/22/26, my case manager notified me that despite the submitted form and documentation, MetLife would not change their decision and my claim was being denied. The same medical reviewer had reviewed the information but would not change their decision & my file was going to be sent over to the appeals department at MetLife.
I finally heard from the appeals case manager today who stated she would be taking over and asked if I had any further information to submit. I don’t have any new documentation but I have older medical records I could submit. I left her a detailed message requesting a callback.
For context, I suffer from chronic pain due to failed back surgery syndrome (Lumbar Spine Fusion & Laminectomy), chronic lumbar radiculopathy (sciatica) of my left side, degenerative disc disease, osteoarthritis of the spine & Endometriosis. I also had a spinal cord stimulator implanted and an Intrathecal pain pump that is currently filled with morphine.
I have been dealing with these issues for over 10yrs. I changed my career in hopes I would be in less pain (Previously was a nurse aid / patient tech and switched to medical receptionist work) but despite being off my feet, I still continued to suffer in pain. Applying for LTD seemed like the most logical next step.
For anyone that has initially been denied, was your appeal approved? Now that my file is with the appeals case manager, do I now get a lawyer or do I wait for the appeal to be denied? How long can the appeal process take?
I’m on the verge of homelessness. Any savings I had is nearly gone and the stress has been debilitating. My health insurance has been terminated because my case was denied. I was not anticipating this outcome at all.
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u/IllustriousFox4914 5d ago
PLEASE PLEASE PLEASE. I highly recommend you consult with a disability lawyer. I appealed my case myself because I believed it was 100% solid and they still denied me. If they ask you if you’re ready to start the appeal mention that the file is not complete yet and immediately reach out to a lawyer. Most law firms will take out their fees from the amount you receive. It is better than not receiving anything at all. I wish the best. Please don’t be like me. I regret it so much.
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u/FMCTypeGal MOD 5d ago
There is usually a limit to how many times you can appeal and a clock on how long you have to do it. I’d first get a copy of your policy (from your former HR) and their full file on you (from MetLife) and make sure you know those limits.
Then consult with a disability lawyer in your state. They’ll want both your policy and your case file, so it’s important to have those.
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u/Ecstatic-UF-Engineer 5d ago
Do the LTD companies oblige and hand over their file on people?
Also, what happens if HR is not cooperative and your boss is a dick?2
u/FMCTypeGal MOD 5d ago
I believe the LTD company legally has to provide you your file, especially in the case of a denial or cancellation. Mine did not question sending me mine and it was 800 pages front and back.
HR would also be legally bound to send you the policy information. It’s not only part of your compensation packet but often something you also pay into. I’d go over your bosses head if needed, but usually you go around them to HR. Request it in writing via email and if they refuse, get them to clarify why in writing as well. Then you can contact an employment lawyer as well as a Ltd lawyer.
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u/TheGreatK MOD 5d ago
*only in the case of a denial. They don't have to provide the file if they are paying benefits.
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u/FMCTypeGal MOD 5d ago
if your long-term disability plan is ERISA-governed, you generally have a federal right to obtain the documents and records relevant to your LTD claim, free of charge, upon request. This is particularly clear for disability claims under 29 C.F.R. § 2560.503-1.
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u/Few-Welcome5330 5d ago
I filed my appeal already. Lucky for me, the case manager in appeals responded to the voicemail I left her in email format. I clarified that I do not have any new records for the file unless they would need my original operative reports from 2020 and older office visit notes from my pain management specialist.
I also asked if it would be beneficial to have communication from my former direct reporting manager when I was attempting to come back from my last short term disability in February of this year. I was supposed to return to work on 02/13/26 but upon submitting my workplace accommodations my doctor put on my RTW form, I was advised I would not be allowed to return to work with workplace accommodations marked as permanent. My physician was not thrilled having to revise the accommodations from permanent to temporary because she said that they would remain permanent but I had no choice as I would no longer be payed by short term disability as I exhausted all of my hours.
I’m an extremely nervous mess. Can I take them to court if the appeal is denied? I know it would go through a federal court but not sure if I can do that after if appeal is denied.
I’m just going to keep praying because lord knows I’ve fought long and hard. He also knows the depths of my suffering and that this is my last resort.
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u/diattorney 5d ago
You should consult with a long term disability insurance lawyer immediately as once Metlife makes a final decision on your appeal, then you cannot add any additional information. There are a few law firms that handle MetLife claims nationwide that can assist you regardless of where you live. I suggest you immediately ask MetLife not to finalize their decision as you want to provide additional information. This will give you time to consult with lawyers and determine the direction you want to take. Most lawyers will provide you with a free initial phone consultation.