Metropolitan Life Insurance Company LTD denial appeal
What MetLife requires, why it denies these claims, and the specific record you need to build inside the ERISA 180-day window.
Where to file
- Appeals unit
- MetLife Disability Appeals Unit
- Mailing address
- MetLife Disability, P.O. Box 14590, Lexington, KY 40512-4590. MetLife's Lexington operations center processes group disability appeals; confirm the exact address on the denial letter for your plan.
- Phone
- 1-800-300-4296 (MetLife Disability)
- Portal
- mybenefits.metlife.com
Policy basis
ERISA 29 CFR 2560.503-1 for employer-sponsored group LTD; state insurance code for individual disability. MetLife group certificates set a 180-day appeal window and a 45-day decision window (extendable by 45 additional days).
Source: Metropolitan Life Insurance Company claim materials
"MetLife disability claim materials: 'You may appeal a denied claim in writing within 180 days after receiving notice of the denial.'"
Common MetLife denial reasons
- •Any-occupation definition not met after the 24-month own-occupation period
- •Insufficient objective evidence of functional impairment
- •Reviewer physician contradicts treating provider on the paper review
- •Mental / nervous condition 24-month limitation
- •Failure to apply for Social Security Disability Insurance (SSDI offset language)
Key policy points
- •MetLife routinely requires SSDI application as a condition of continued LTD payment and takes the SSDI award as an offset — but a denied SSDI claim does not automatically justify a MetLife denial.
- •MetLife's paper reviews are contracted through vendors such as MCMC, ExamWorks Clinical Solutions, and Dane Street; each report must appear in the claim file.
- •Under 29 CFR 2560.503-1(h)(4), MetLife must share any new evidence generated during appeal before deciding.
- •The pre-existing condition clause typically uses a 3/12 look-back / look-forward window.
Override strategy
Obtain the full claim file with all vendor reviewer reports and rebut each in writing. If MetLife cites the any-occupation standard, retain a vocational expert to test whether the identified alternative occupations actually exist locally at the required wage. Where SSDI has been awarded, cite the ALJ decision as persuasive evidence of functional limitation — the standards are different but the underlying medical record is the same.
MetLife reverses at meaningful rates when the appeal record includes an SSDI award, a vocational rebuttal, and specific reviewer-by-reviewer objections.
Evidence that overturns
- •Full claim file with vendor reviewer reports and CVs
- •Treating physician rebuttal APS keyed to reviewer findings
- •SSDI award letter or ALJ decision (if awarded)
- •Vocational expert report on alternative occupations at the required wage percentage
- •Objective testing: MRI, EMG, neuropsych, FCE, cardiopulmonary exercise test
- •Employer job description and productivity records if available
MetLife individual disability policies (issued before the 2016 sale of the retail life business to Brighthouse) may still be administered by MetLife and follow the state code, not ERISA.
How long do I have to appeal a MetLife LTD denial?+
180 days from the date of the denial letter under ERISA 29 CFR 2560.503-1 for group employer plans. Missing this deadline forfeits the right to sue in federal court.
Where do I send a MetLife LTD appeal?+
MetLife Disability, P.O. Box 14590, Lexington, KY 40512-4590. MetLife's Lexington operations center processes group disability appeals; confirm the exact address on the denial letter for your plan.
Why did MetLife deny my LTD claim?+
The most common grounds are Any-occupation definition not met after the 24-month own-occupation period; Insufficient objective evidence of functional impairment; Reviewer physician contradicts treating provider on the paper review. The exact ground is stated in the denial letter.
Can I get my MetLife claim file?+
Yes. Under 29 CFR 2560.503-1(h)(2)(iii) the carrier must produce the full claim file — every reviewer physician report and vendor engagement — free of charge on written request. Request it on day 1 of the appeal window.
Does an SSDI award help my MetLife LTD appeal?+
An SSDI award is not binding on MetLife, but it is persuasive: SSA's medical determination is based on the same clinical record, and federal courts have criticized carriers that ignored an SSDI award while collecting the SSDI offset from the claimant.
Upload the denial letter. We'll request the full claim file from MetLife, rebut each reviewer physician by name, and prepare the appeal within the ERISA 180-day window.