Metropolitan Life Insurance Company is one of the largest life insurers in the country, and it is also one of the most frequently litigated. MetLife denials often rely on alleged medical misrepresentations, suicide determinations, beneficiary disputes, or discretionary interpretations under ERISA governed plans. Courts across multiple federal circuits have reviewed these denials closely, sometimes siding with MetLife and other times finding its decisions arbitrary, unsupported, or legally flawed.
The ten cases below illustrate how judges evaluate MetLife’s claim handling and what beneficiaries can learn from those rulings.
Case 1: No Proof of Accident in AD&D Claim
In a case involving Metropolitan Life Insurance Company, a daughter sought accidental death benefits after her mother died from an unexplained cause. MetLife denied the claim, stating there was insufficient evidence the death was accidental.
Despite submission of a detective’s report and circumstantial evidence, both the district court and the Tenth Circuit upheld the denial. The courts emphasized that the burden of proving an accident rests with the beneficiary in AD&D claims.
Case 2: Medical History Misrepresentation Reversed on Appeal
MetLife denied a claim after a woman died of a heart attack, alleging she failed to disclose hypertension, diabetes, and obesity. The district court agreed with MetLife.
On appeal, the Ninth Circuit reversed, finding MetLife failed to show the alleged omissions were both material and intentional. The court stressed that inaccurate answers alone do not justify rescission without proof the insurer would have declined coverage.
Case 3: Gunshot Death Classified as Suicide
In another MetLife case, the insured died from a gunshot wound. MetLife denied the claim under the suicide exclusion. The beneficiary argued the evidence did not conclusively prove suicide.
Both the district court and the Eleventh Circuit sided with MetLife, relying on police and medical examiner findings that established intentional self harm. This case confirms that suicide exclusions are enforceable when intent is clearly supported by the record.
Case 4: Drug Overdose Ruled Accidental
MetLife denied benefits after an insured died from a drug overdose, treating the death as self inflicted. The district court dismissed the claim.
The Third Circuit reversed, holding that MetLife ignored evidence suggesting the overdose was accidental. The court found the insurer’s conclusion unsupported and remanded the case, showing that intent must be proven, not assumed.
Case 5: Heart Attack and Alleged Concealment
After an insured died of a heart attack, MetLife denied the claim based on alleged nondisclosure of heart conditions. The district court ruled for MetLife.
The Fourth Circuit reversed, finding MetLife’s decision arbitrary and capricious. The appellate court criticized the insurer for relying on speculation rather than concrete underwriting evidence.
Case 6: Stroke Death and Material Omission Upheld
MetLife denied benefits after a stroke death, citing failure to disclose atrial fibrillation and related conditions. The beneficiary challenged the denial.
The Sixth Circuit upheld MetLife’s decision, concluding the omissions were material and that the insurer reasonably relied on medical records. This case demonstrates that courts will uphold denials when evidence strongly supports material misrepresentation.
Case 7: Cancer Death and Multiple Omissions
In another case, MetLife denied a claim after the insured died from cancer, alleging failure to disclose melanoma and subsequent diagnoses. Both the district court and Seventh Circuit upheld the denial.
The courts found the misstatements material and ruled MetLife acted in good faith. This case reflects how extensive undisclosed medical history can defeat a claim.
Case 8: Beneficiary Dispute Resolved Against MetLife
A widow challenged MetLife’s denial based on a beneficiary designation that named an ex spouse. MetLife relied strictly on the written designation.
The Ninth Circuit ruled MetLife abused its discretion by ignoring evidence of the insured’s intent and surrounding circumstances. The court ordered payment to the widow, showing that beneficiary disputes are not always resolved by form language alone.
Case 9: Diabetes and Heart Disease Omission
MetLife denied a claim after an insured died of a heart attack, citing nondisclosure of diabetes and coronary disease. The Second Circuit upheld the denial.
The court concluded the misrepresentations were material and that MetLife’s investigation was reasonable. This case reinforces that some denials survive judicial review.
Case 10: Pulmonary Embolism and Arbitrary Denial
MetLife denied a claim after a pulmonary embolism death, alleging nondisclosure of deep vein thrombosis and anticoagulant use. The district court dismissed the case.
The Eighth Circuit reversed, finding MetLife’s decision arbitrary and unsupported by the underwriting record. The appellate court ruled the alleged omissions were not material to coverage.
What These MetLife Cases Reveal
Across federal circuits, courts consistently apply several principles:
MetLife must prove material and intentional misrepresentation
Suicide exclusions require evidence of intent
Overdose deaths require careful intent analysis
ERISA plans are reviewed for arbitrariness and fairness
Beneficiary intent can override rigid administrative interpretations
MetLife wins some cases and loses others, depending on evidence quality and claim handling.
Challenging a MetLife Claim Denial
A denial from MetLife is not the end of the road. Many denials are reversed on appeal or in court when insurers rely on assumptions, incomplete investigations, or overly aggressive interpretations of policy language.
Effective challenges focus on underwriting standards, materiality, procedural compliance, and whether MetLife exercised discretion fairly and consistently.
Frequently Asked Questions
Can MetLife deny a claim for misrepresentation?
Yes, but only if it proves the omission was material and intentional. Courts frequently reverse denials when this burden is not met.
Are all overdoses treated as suicide?
No. Courts often require clear evidence of intent before allowing suicide exclusions to apply.
Do courts defer to MetLife under ERISA?
Courts give deference only when decisions are reasonable. Arbitrary or unsupported denials are often overturned.
Can beneficiary disputes override policy forms?
Sometimes. Courts may enforce the insured’s intent when strict reliance on forms produces unfair results.