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
- 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
- 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:
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).
||Should you receive a denial of benefits, your pay will be
suspended until either your claim is reinstated or you return
||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."