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Benefits Denial
In some instances, MetLife may deny your claim for benefits. This section explains the basis for these actions.

Reasons for Denial

  • Failure to Contact MetLife By the Eighth Day - MetLife will deny your claim for STD coverage under the Managed Disability Plan if you fail to inform them of your absence by the eighth consecutive calendar day beginning with your first day absent from work.
  • Failure to Provide Information in a Timely Manner - It is your responsibility to make sure that your doctor sends any necessary paperwork supporting your claim to MetLife in a timely manner and maintains good communication with MetLife throughout the process.
  • Lack of Objective Medical Data - MetLife evaluates your claim based on objective medical data. If your doctor does not provide MetLife with objective medical data that your condition prevents you from doing your job at Verizon Wireless, your claim will be denied.

Denial of Benefits

If your claim is denied, your pay will be stopped. In addition, MetLife will notify you in writing. The letter will:

  • Explain and provide details on why your benefits were denied,
  • Describe any additional information you may need to provide to support your claim, and
  • Provide you with appeal procedures, timelines and your rights.

If you have a denial of benefits, your attendance record, pay or employment status may be affected as outlined in the following table:

Attendance Record

Should you receive a denial of benefits, your absence will be considered as "unexcused," unless you are certified for an FML. You should return to work immediately.

If you do not return to work, you must contact Human Resources and your supervisor immediately to provide an update on your status, otherwise you risk termination for job abandonment. Also, you must submit an appeal to MetLife within 180 days from the date you are notified of the denial, in accordance with the Employee Retirement and Income Security Act (ERISA).

Pay Should you receive a denial of benefits, your pay will be suspended until either your claim is reinstated or you return to work.
Employment Status If your claim is not certified and you do not contact Human Resources and your supervisor to provide an update on your status, you risk termination for job abandonment. However, any change in your employment status will not affect your right to appeal the termination of benefits under Verizon Wireless' STD Plan.

Appealing MetLife's Decision

If you appeal the decision, you will be required to use all of your available and remaining federal and state leave time. Then, you may apply for a Leave of Absence (LOA) through your department. Granting a Leave of Absence is at the discretion of your department and Human Resources, and placement on a Leave of Absence will not guarantee job reinstatement. Additionally, if your request for an LOA is granted, your LOA will run concurrently with your available and remaining federal and state leave time.

MetLife must inform you of a decision based on your appeal within 45 days of the time they receive your appeal. If MetLife reverses the denial and certifies your claim, your benefit payments will be reinstated back to your last day of payment. If MetLife upholds their original decision, the suspension of your payments will stand and your absence will remain "unexcused."

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