Claims Relating to a Benefit
If your initial claim relating to the payment or denial of a Postretirement Life Insurance Plan benefit has been denied by Metropolitan Life Insurance Company Insurance Company, you will receive written notice of the denial within 90 days of receipt of the initial claim unless, due to special circumstances, an additional 90 days is required. Such notification will include:
  • the specific reason(s) for the denial of the claim;
  • a reference to the Plan provision(s) which apply to the denial;
  • a description of any additional material or information necessary from a participant or beneficiary to perfect the claim and an explanation of why such material or information is necessary;
  • a description of the Plan's review procedures and the time limits applicable to such procedures; and
  • a statement of the participant's or beneficiary's right to bring a civil action under section 502(a) of ERISA following an adverse benefit determination on review.
Appeals
If your initial claim relating to the payment or denial of a benefit has been denied by Metropolitan Life Insurance Company, you may submit a written appeal to Metropolitan Life Insurance Company. The appeal should be sent to Group Insurance Claims Review at the address of the Metropolitan Life Insurance Company office which processed your claim. Your appeal to Metropolitan Life Insurance Company must be received within 60 days of your receipt of notice that your claim has been denied by Metropolitan Life Insurance Company.
No special form or format is required in submitting a written appeal; you may submit written comments, documents, records and other information relating to your claim. You may also request, free of charge, access to, or copies of, all documents, records and other information relevant to your claim for benefits. The review of your appeal by Metropolitan Life Insurance Company will take into account all comments, documents, records and other information submitted by you relating to your claim, without regard to whether such information was submitted or considered at the initial benefit determination.
If Metropolitan Life Insurance Company denies your appeal, you will receive a written response which will include:
  • the specific reason(s) for the denial;
  • a reference to the Plan provision(s) which apply to the denial;
  • a statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim for benefits;
  • an explanation of any voluntary appeal procedures offered by the Plan and your right to obtain information about such procedures; and
  • a statement of your right to bring an action under section 502(a) of ERISA.
You will receive a final ruling from Metropolitan Life Insurance Company within 60 days of Metropolitan Life Insurance Company's receipt of your appeal unless, due to special circumstances, Metropolitan Life Insurance Company requires additional time to respond, up to another 60 days.
You may bring an action under section 502(a) of ERISA only after you have exhausted all levels of review on appeal.