MetLife Insurance Claim Denial Attorney

Skilled MetLife / Brighthouse Insurance Company Claim Attorneys Serving Clients With Denials

MetLife denied your disability, life, or long-term care claim. That denial does not end your right to the full policy benefits you paid for. Pillsbury & Coleman, LLP represents California policyholders against MetLife in ERISA appeals, bad faith litigation, and federal court.

Since 1991, our firm has represented policyholders exclusively against insurance carriers, never insurers. We have recovered over $1 billion for clients and secured the largest disability insurance bad faith verdict in California history.

The Metropolitan Life Insurance Company, commonly referred to as MetLife, or more recently, Brighthouse, established a leadership position among U.S. life insurance providers in the early 20th century. MetLife / Brighthouse today administers group life, disability, and long-term care benefits for millions of policyholders nationwide. MetLife and Brighthouse market a wide range of life insurance, disability insurance, long-term care insurance and other types of policies and coverage. The company provides and manages group plans governed by the federal law ERISA under 29 U.S.C. § 1001 et seq. as well as individual policies subject to California insurance law.

Why a MetLife / Brighthouse Claim Denial Requires Specialized Counsel

MetLife claim denials present distinct legal issues that general practice attorneys and personal injury firms do not regularly encounter. Group MetLife policies issued through an employer are typically governed by ERISA, which limits remedies to recovery of benefits and generally forecloses punitive damages. Courts reviewing an ERISA denial apply either the arbitrary and capricious standard or de novo review, depending on the plan’s language granting MetLife discretionary authority. Individually purchased MetLife policies fall outside ERISA and remain subject to California bad faith law, including the implied covenant of good faith and fair dealing and the potential for punitive damages.

MetLife has relied on in-house physician reviews to override treating physician opinions in disability and mental health claims, a pattern our attorneys have litigated directly. In Garcia-Pardini v. MetLife, described below, MetLife terminated ERISA disability benefits after an in-house psychiatrist disagreed with the treating physician’s disability assessment without examining the claimant. Effective counsel must understand the administrative record MetLife compiles during an ERISA appeal, since that record typically controls what a federal court may later consider.

Firm Authority & Track Record

If you believed your income and future were protected under a MetLife insurance policy, but you have filed a claim and received a denial or encountered other problems, we encourage you to call our San Francisco office at (415) 433-8000 or contact us for a free case evaluation.

• Founded in 1991, one of California’s only firms exclusively representing policyholders against insurance carriers.
• Over $1 billion recovered for California policyholders denied benefits.
• Secured the largest disability insurance bad faith verdict in California history, a $31.7 million jury verdict against UnumProvident in Chapman v. UnumProvident.
• Partner Terrence J. Coleman is recognized as an ERISA expert by the Northern District of California.
• Martindale-Hubbell AV Preeminent rated attorneys.
• Named to Best Lawyers in America and Super Lawyers.
• Members of the American College of Coverage Counsel (ACCC).
• Represent policyholders throughout California and nationally in federal court.

Case Result

Dollar Amount & Result Type: ERISA Disability Benefits Recovery Following Summary Judgment [CONFIRM SETTLEMENT AMOUNT — DISCLOSURE PERMISSION REQUIRED]

Defendant: Metropolitan Life Insurance Company (MetLife), a national group life and disability insurer

Bad Faith / Wrongful Denial Conduct Proven: MetLife terminated an ERISA-governed disability claim after an in-house psychiatrist disagreed with the treating physician’s disability assessment, without conducting an independent examination of the claimant

Recovery: Pillsbury & Coleman obtained a summary judgment order permitting the case to proceed to trial. The case successfully settled shortly thereafter, recovering benefits for our client, a Human Resources Manager disabled by major depression

Source: Garcia-Pardini v. MetLife, Pillsbury & Coleman Successes — Disability Insurance Results.

What Constitutes MetLife Bad Faith or Wrongful Denial

• Terminating an ERISA disability claim based on an in-house physician’s paper review that overrides the treating physician’s findings
• Applying the ERISA arbitrary and capricious standard to a plan that does not grant MetLife discretionary authority to interpret its terms
• Retroactively canceling a life insurance policy through post-claim underwriting after a claim is filed
• Relying on IME opinions from physicians retained and compensated by MetLife rather than the claimant’s treating physicians
• Applying the “any occupation” definition of disability before the policy’s own-occupation period has expired
• Delaying payment of a California-governed claim beyond 40 days without a written explanation, in violation of Cal. Ins. Code § 790.03(h)
• Denying long-term care claims MetLife issued before exiting the LTC market, leaving policyholders to contest denials on legacy policies
• Discounting psychiatric or mental health disability claims for lack of “objective” evidence unavailable for such conditions

Frequently Asked Questions

How long do I have to sue MetLife for a wrongful denial in California?

California’s statute of limitations for breach of a written insurance contract is four years under Cal. Code Civ. Proc. § 337, though many MetLife policies impose a shorter contractual suit limitations clause. If your claim is governed by ERISA, no state limitations period applies directly; instead, courts borrow the most analogous state period or apply a period set in the plan documents. Confirm your applicable deadline before your rights lapse.

What does it mean when MetLife acts in bad faith under California law?

Bad faith means MetLife breached the implied covenant of good faith and fair dealing owed to every California policyholder. Cal. Ins. Code § 790.03 identifies specific unfair claims practices, including misrepresenting policy provisions and failing to conduct a full investigation. A bad faith finding allows recovery beyond policy limits, including attorney fees under Brandt v. Superior Court.

Can I recover punitive damages against MetLife for denying my claim?

California permits punitive damages upon clear and convincing evidence that MetLife acted with malice, oppression, or fraud in denying your claim. This remedy is available only for individual policies governed by state law, not ERISA-governed group plans. Our firm has pursued punitive damages exposure in bad faith litigation against major carriers, including MetLife.

Is my MetLife disability claim governed by ERISA or California law?

If MetLife issued your policy through an employer-sponsored group benefit plan, ERISA preemption generally applies and limits your remedies to recovery of benefits and attorney fees. If you purchased your MetLife policy individually, California bad faith law governs and permits broader damages. Our firm evaluates your plan documents to determine which framework applies and handles both.

MetLife required an independent medical examination — what are my rights?

The physician conducting a MetLife-requested IME is retained and compensated by MetLife, not by you, and may hold a bias toward denial. You may bring an observer to the examination in most circumstances. MetLife cannot use a single IME to override years of consistent treating physician records without adequate justification.

How long does it take to resolve a MetLife claim denial in California?

A MetLife ERISA appeal generally proceeds through the plan’s internal administrative review before litigation becomes available, a process that typically spans several months. Litigation itself commonly resolves within twelve to twenty-four months depending on the complexity of the medical record. Cases carrying significant punitive damages exposure frequently settle before reaching trial.

How does Pillsbury & Coleman charge for MetLife bad faith cases?

Pillsbury & Coleman typically represents MetLife policyholders on a contingency fee basis. There is no fee unless we recover compensation on your behalf. In bad faith cases governed by California law, attorney fees may also be recoverable directly against MetLife under Brandt v. Superior Court.

What documentation should I preserve after MetLife denies my claim?

Preserve the denial letter, all correspondence with MetLife claims handlers, your policy or certificate of coverage, and every medical record submitted with your claim. Also retain explanation of benefits statements, internal claim notes if accessible, and any surveillance disclosures MetLife provides. These documents form the administrative record on appeal.

MetLife says I can do “some work” — can it terminate my disability benefits?

If your MetLife policy provides an own-occupation definition of disability, MetLife cannot terminate your benefits simply because you can perform some other type of work. The own-occupation definition asks only whether you can perform the material duties of your own occupation. MetLife frequently shifts to an any-occupation standard prematurely, before the policy’s own-occupation period has expired.

Has MetLife been sued before for wrongful denial of disability claims in California?

Yes. In Garcia-Pardini v. MetLife, Pillsbury & Coleman obtained a summary judgment order against MetLife after it terminated ERISA disability benefits based on an in-house psychiatrist’s review. That case, along with other litigation our firm has brought against MetLife, documents a pattern of overriding treating physician opinions with internal reviews. Contact our firm to discuss whether similar conduct affected your claim.