Recent News About Aetna and Long Term Disability Claims:
- In Smith v. United Parcel Service, the District Court in Nevada held that Aetna abused its discretion in denying short and long-term disability benefits to the claimant. The court found that the claim was unreasonably denied based primarily on an alleged lack of objective medical findings to support impairment. Importantly, the court said that because Aetna felt the medical records were insufficient to verify the plaintiff's disability, it was imperative that they inform the plaintiff of the deficiency so that he might proffer any additionally needed documentation.
- Ben Glass Law is appealing a case to the 4th Circuit Court of Appeals. In Thomas v Aetna, Aetna refused to give the claimant, a former Booz Allen Hamilton employee, a copy of her claim file when she asked for it. We also claim that when Aetna knows that a particular piece of medical evidence it deems important it missing, it must tell the claimant what that evidence is. We content that this violated ERISA's guarantee of a full and fair review. We are seeking a remand to Aetna and the payment of our attorney fees.
- In North Carolina, in Rafaey v. Aetna, the court ruled that Aetna had not abused its discretion in determining that the claimant, a former Bank of America employee, was not disabled. For years the claimant had suffered the effects of a viral illness. She had been treated by many doctors, including those at the Mayo clinic. In reaching its decision the court was critical of the claimant's failure to do more than merely point out discrepancies in the medical record, note that they were not addressed by Aetna, and claim that she was not given a fair review.
- In California, in DeVries, v Aetna, decided June 2020, the court rejected Aetna's attempt to limit discussion of a claimant's occupational duties to the physical aspects of the job. The insurance company must address the cognitive parts of one's occupation. This case is an important victory for those who suffer from chronic fatigue. The court also pointed out that labeling a job as "sedentary" and saying "well, you can do sedentary work" is not good enough to deny a claim where the definition of disability is, as most are, the inability to perform the occupational duties.
Even though you have paid your disability insurance premiums for years, disability insurance companies see your claim as a major loss if your claim is approved. These companies scrutinize claims closely, looking for any reason to deny. The claims adjuster is not there to “help” you, no matter how nice they sound on the phone. Trust us on that.
If we could trust insurance companies to approve (or deny) claims fairly, we wouldn’t need attorneys!
We have seen claims denied at any time, even years after the initial approval! For example, your claim may have been approved initially, but after two years, when your claim rolls into the “Any Occupation” period, the insurance company will be looking for a way to terminate your benefits.
In our experience, even claims that are denied but successfully appealed are often denied again and again. We believe there are many claims that are denied just because the insurance company believes there is a low chance the claimant will hire an attorney to appeal their decision. Frankly, there are few ERISA experienced attorneys here in Virginia.
Why Was My Aetna Long-Term Disability Claim Denied?
Aetna long-term disability claims can be complicated. If you are already dealing with a claim denial yourself, this is probably no surprise. Claims are denied often, most of the time for one of two reasons.
- The claimant does not meet the conditions for being disabled as defined in his/her disability policy, but often…
- The claimant is a victim of a frivolous denial of their claim
Unfortunately, there is little that can be some for claimants who don’t meet their contract’s definition of disabled. However, frivolous denials, which are more common than you think, can often be overturned with the help of a long-term disability attorney.
Remember, the insurance company has a financial incentive to deny you. However, how can the insurance company deny you if you have a completely reasonable claim? Here’s why:
- They are counting on you to simply walk away. One of our clients was told recently by a claims adjuster that “some people simply give up because of all the paperwork we send them.”
- The insurance company is counting on frustrating and confusing you by repeatedly denying you. If you walk away, the insurance company has bullied you out of your benefits.
- They want you to appeal without an attorney. Respected local federal judge Claude M. Hilton recently said from the bench “these people need lawyers!”
Taking on the insurance company yourself is a brave but often a costly mistake. The insurance company will nearly always win when if you appeal your claim on your own – they simply have the resources and experience to outmaneuver and overpower most claimants.
Here’s How BenGlassLaw Can Help You Right Now with Your Aetna Claim
- Fax/email/mail us your denial letter. We will review it and give you a detailed strategy for moving forward. This service is FREE, but you must act promptly before your timeline to appeal runs out. You only have 180 days within which to file all your arguments, witnesses, medical articles, legal citations, updated medical records, and narratives.
- Download our free book, Don’t Try This at Home. Don’t Try This at Home is our premier guide on ERISA disability claims where you will learn about why insurance companies deny claims and how you can appeal.
- Contact us about a consultation. We can review your claim and the evidence you have supporting your appeal. Additionally, we will talk to you about how this may affect your current employment and answer any other questions you may have. (There is a nominal fee for this consult, but we have saved claimants thousands of dollars just in one meeting.)
- If your benefits have been denied and you did your own appeal, we can only help you if you have a second appeal available to you. Really, you should contact an attorney before your claim gets this far - second appeals are tough, and there is often extra work to be done by untangling errors made in the first appeal if it was not prepared by an ERISA experienced attorney.
You Can Speak with Our Team of Experts About Your Disability Claim by Calling Our Office at (703)584-7277.
What Information Should You Gather to Appeal Your Aetna Disability Claim?
Before you and your attorney appeal an ERISA disability claim, you need to gather documents from:
- Your Employer
Often claims are denied because there is a dispute over whether you can perform your job duties with your disability. It is helpful to have a description of your job provided by your employer that you can review and compare to the description of your duties in your disability claim. “Sedentary” jobs are notorious for generating disability denials, but “sedentary” may not cover the full scope of your duties.
- Your Doctor
How your doctor interprets your disability and your ability to work is critical for your appeal. You probably already have your doctor’s support, but the insurance company may disregard or overlook your doctor’s input on your disabling condition.
- Your Disability Insurance Provider (Aetna)
Most people don’t know this, but you can and SHOULD request your claim file from Aetna. You should know and understand why the insurance company denied you, and you will want to review their “evidence” about your claim. Bring this with you when you meet an attorney, it will help the attorney understand why you were really denied when reviewing your claim.
Why Most ERISA Long-Term Disability Claims are Denied and How Victims Lose Out on a Fair Recovery - Find Out More in Our Disability Claim Guide, Don't Try This At Home
If Aetna denied your long-term disability benefits, you need to download this free guide right now! In most cases, you have only 180 days within which to file a properly framed appeal. A respected federal judge has said that when you have one of these policies you are purchasing an invitation to a "legal ritual" that you will lose.
Ben Glass's Long-term Disability Book Will Show You:
- How the way you fill out your claim form can wreck your case;
- How doing the appeal yourself can give the insurance company an excuse to deny your claim;
- Why a Federal Judge said that claimants without an experienced ERISA disability attorney are at a 'distinct disadvantage' when appealing their claim denial;
- What you must have in your hand before you file your claim if you want to have any hope of getting paid;
- How to find a board-certified lawyer;
- How one former insurance company employee describes the claim denial process inside one of the world's largest disability insurance companies (you will be shocked);
- How the insurance companies use video and other secret surveillance to try to deny you benefits;
- How one company used an errant checkmark on a physician's form to deny benefits and what we did about it to get benefits restored.
We want to get our guide in your hands right now. You will also have an opportunity to request our disability claim information package after you request this guide.
Ben Glass walks you through the process in his free book, Don't Try This at Home - Your Disability Claim Guide. It's free for Virginia residents!
This free book should be read by:
- Anyone who is filing a disability claim or has already been denied.
- Any doctor who treats patients who are making long-term disability claims.
- Anyone who is going through the disability appeals processes and wants to know more.