Skip to content

Helping Disabled Claimants Nationwide "Whatever It Takes" to Get Your Disability Benefits Paid

Facebook Twitter Get Updates

Free Phone Consultation Nationwide
CALL (800) 682-8331
Click to be called now

We offer no fee or cost unless you get paid

Aetna and The Rawlings Company LLC Seek to Reduce Your Disability Benefit

Attorney Stephen JessupAuthor: Attorney Stephen Jessup

Have you received a mysterious letter from Aetna with The Rawlings Company LCC emblazoned across the top?

We recently received letters on Aetna letterhead, referencing our clients’ claims for disability, which start with: “Aetna Disability administers disability benefits under the group plan sponsored by your employer. We are requesting your cooperation in providing some additional detailed information about your claim, because we believe it may be the result of an accident or injury for which a third party (another person, organization, or insurer) may have some liability.

So what does this mean? To put it simply Aetna is trying to find creative ways to say you may owe them money!

Offsets and Other Income

If you are on claim for long term disability benefits under an ERISA governed group long term disability policy chances are your policy allows the insurance company to reduce your benefits for “Other Income.” The most common example, and maybe one you have experienced, is Social Security disability. Essentially, if “someone” is paying you money for your disabling condition, the insurance company is going to reduce their obligation to you and possibly request a repayment of a prior overpayment.

Another lesser known example of “Other Income” is the proceeds of any settlement or judgment resulting from the actions of a third party that contributed to your disability. For instance, if you were involved in a motor vehicle accident and because of your injuries you filed for disability under your employer’s disability policy and you receive settlement proceeds or a judgment at trial, your insurance carrier could be entitled to repayment of the money already paid out to you.

The Rawlings Company LLC

Pursuant to their website, The Rawlings Group is the “recognized leader in healthcare subrogation services field.” On the main page of their website they boast: “MAXIMUM RECOVERIES FROM THE INDUSTRY EXPERT for the services we provide, The Rawlings Group has an unbeaten record of recovering more money for more health plans than any other vendor.” (Subrogation is the legal doctrine whereby one person takes over the rights or remedies of another against a third party)

A simple search in Google reveals not so flattering information from individual insureds claiming to have been harassed by The Rawlings Group, medical procedures not being covered and vague implied threats of unknown proceedings.

What’s this mean for you?

Honestly, we are not quite sure yet. For one client in which we received the Aetna/Rawlings Company letter, the nature of the disability stems from a cancerous tumor from over 5 years ago. Hardly a case that might be the result of the actions of a third party! This leads us to believe that maybe this is a shot-in-the-dark form letter being sent by Aetna to see if there is a way for them to further lessen their financial obligation to provide you benefits under your group disability policy.

The disability attorneys of Dell and Schaefer quickly sought clarification as to the nature of these letters as we did not feel comfortable having our clients sign what we consider overly broad authorizations allowing some a company that is not mentioned anywhere in the plan documents, to collect whatever information they want. To date we have not received any response from Aetna as to our inquiries.

If you have received a letter from Aetna with indications of The Rawlings Company wanting to investigate your claim, please feel free to contact Attorneys Dell and Schaefer.

There are 43 opinions so far. Add your comment now.

Amy Vierra:

I received a letter from The Rawlings Group on behalf of my insurance company HealthNet. They indicated “that HealthNet recently processed a claim for the patient (me) listed above. According to your HealthNet contract, when a member is injured through the act of another person and is entitle to recovery from a third party, Health Net is entitle to reimbursement if the member receives any recovery for the medical expenses”, etc.

The strange thing is, I have never heard of and have never received an EOB for the dr. referenced in this letter. I did have a trip to the ER on the date referenced, but it was for an infected tooth and I have already paid the doctor that I received a bill from and an EOB from. What do you think is going on here?

Attorney Stephen Jessup:

Amy,

As indicated in the post, Rawlings Group is a subrogation company that has apparently been hired by HealthNet to recover payment from another source for some alleged treatment received. I would recommend you contact HealthNet to inquire as to the reason for the letter and to inform them that you have never treated with the doctor they referenced.

Sara:

I have received an “audit” from Aetna and Rawlings Company asking me for Newborn information, date of birth, address, and my current coverage carriers and phone numbers. I no longer have Aetna coverage (it ended 9-30-12, and I did have a baby during that time, 8/12).

Am I legally obligated to provide this information considering I haven’t had aetna insurance for over a year? I’m not going to just hand over my personal information unless I have to!

Attorney Stephen Jessup:

Sara,

It appears that they are contacting you with respect to a health insurance matter that I would presume has already been paid by Aetna. I would suggest contacting Aetna in writing to determine why you are receiving the notice. I did just that with respect to my client’s long term disability claim and never heard another word from Rawlings.

Nate:

Our 1 year old son fell down some steps and had an ambulance trip to the hospital. I have since received a subrogation form to complete. It was an accident, pure and simple. I’m concerned they will go after the home owners to recoup expenses. What should I do?

Attorney Stephen Jessup:

Nate,

I would advise you to contact a personal injury attorney as this is stemming from an accident as opposed to a disability claim.

Xcamote:

My daughter fell of her scooter on a public sidewalk. The reason was due to extremely uneven lifted pavement, it happened at night where street lights where not working and it was difficult to see. I went to the emergency room, everything went through normally, but now I’m receiving letters from Rawlings requesting the settlement amount from the city before they can come up with a figure of what I owe. I ask them over the phone what I owe them and they tell me they cant disclose that until I report my settlement amount. I haven’t filed a claim with the city yet because they are asking me for medical debts I incurred but Rawlings won’t tell me. Can they do that? Sounds suspicious to me.

Attorney Stephen Jessup:

Xcamote,

You will need to consult with a personal injury attorney as to your rights. Our experience with Rawlings Company, as noted in the article is purely with respect to claims for disability insurance benefits.

Michael M.:

I recently sought pain relief in the form of a cortisone shot in my right elbow for an injury I received 16 years ago related to a fall from a tractor trailer I was legally employed to work on. I also sought a 2nd medical opinion from the same orthopedic surgeon during the same visit for an old dislocating shoulder injury from 7 years ago to which I had an MRI done at the doctors request. Neither one of these injuries had anything to do with Aetna at the time they occurred. Now I am being harassed by the Rawlings Company and I would very much like that to stop ASAP. I receive monthly letters from Rawlings with a threatening tone if I do not respond. I wish the HIPA laws could be leveraged against Aetna for sharing our information to a 3rd party company without our consent. I’m sure there is fine print on some Aetna document I signed that may or may not have contained the word “subrogation”. At the time I signed Aenta’s agreement forms I had no idea what that word even meant.

Attorney Stephen Jessup:

Michael,

Is Aetna your long term disability carrier or health insurance carrier?

Randy:

I also received numerous letters from The Rawlings Company (TRC) asking me to provide them with what I consider to be private, personal information. With all the scams going on today I didn’t respond, as I felt if it was legitimate then Aetna would be contacting me themselves about this and not some second-rate collector of sorts. I constantly receive bogus letters and emails from such people all claiming I “have” to provide them with this or that, so naturally I thought TRC was just another scammer among many. Aetna is my primary health provider but I am disabled with a progressive neurological disease and because of this my clarity of thought isn’t what it used to be, and with all the scams among us anymore I felt this was just another attempt to get personal info. Since my initial “survey” I have received a total of FIVE surveys all claiming that I HAVE to release my info to them, and in simple terms, if I don’t give them whatever they want it will constitute failure to comply with Aetna under the terms of my plan. I have received other similarly worded threats like this over the years from scam outfits so I was hesitant to even contact them about this because it’s difficult for me to speak anymore. Why hasn’t Aetna at least informed their client base they’re using some third-party money collector of sorts (TRC) and that it’s okay to deal with them? Just performing a simple internet search of these people doesn’t paint a very appealing picture so why would I be inclined to release my information to them when even Aetna hasn’t informed me of their partnership with them?

Attorney Stephen Jessup:

Randy,

I would agree with you and seek confirmation from Aetna that Rawlings is in fact an authorized representative of the company as it relates to your claim.

Michael M.:

Hi Stephen,

Aetna is my primary (only) health insurance carrier. Unlike Randy in the last post, I have received confirmation that Rawlings is authorised to represent Aetna. However I did not solicit the services of Rawlings and I feel threatened by Rawlings as I am not comfortable with this process.

Attorney Stephen Jessup:

Michael,

I would discuss your concerns with an Aetna representative. Rawlings sole purpose is to see if someone else is liable for payment of services. If they find said source it saves Aetna money.

Michael M.:

I understand what you’re saying Stephen and I have already had that discussion with my Aetna representative. I am not interested in protecting Aetna’s interests. I pay for their service. I do not expect to have Aetna share my private information with a 3rd party “collection agency” on behalf of Aetna for Aetna. Nor do I intend to cooperate with Rawlings. Regardless of who is liable. In my case no one is liable for my injuries so they would not need to worry in the first place. All they did was upset me when I learned what the subrogation process is. I am sadly disappointed that the US government does not protect ordinary citizens from the invasive nature of subrogation. I guess I don’t understand how the HIPAA laws are supposed to protect people because both Aetna and Rawlings have obviously found a successful way to challenge it or they would not be harassing people like they do.

Josefine:

Hi Stephen,

I recently received a letter from the rawlings company asking me to fill out their questionnaire. I had an accident (slip and fall) two years ago and won the injury claim ($300.000). Last year, I signed up with Aetna and then this year I had another surgery done that had to do with my accident from two years ago. Now I got the letter from Rawlings. Do you think if I fill it out and tell them about winning my injury claim I will have to pay Aetna back for this recent surgery? Can they do that? Aetna pre-authorized the surgery. Thank you.

Attorney Stephen Jessup:

Josefine,

I am not sure how your health insurance policy reads but there may be some right to subrogation by Aetna. I would suggest you review your health insurance policy and possibly contact Aetna for clarification.

Brendan S.:

I am getting harassed by Rawlings Company LLC. What happens if I just ignore them?

Susan H.:

Hi, I am insured with Aetna through my husband, and I am on Social Security Disability. Now, the husband has been getting letters from Rawlings saying that Aetna Traditional periodically requires info from our members to update our records and ensure accurate claim payments.

I do not feel comfortable in giving my Medicare ID#, which is my SS# and if I’m receiving SS benefits (I do not have Part B, just Part A) as it’s not of their business. What are my options at this point? Would appreciate any suggestions. Thank you.

Attorney Stephen Jessup:

Susan,

Aetna does use Rawlings to investigate claims to determine if there is a right for subrogation under the policy (if someone else is responsible for your disability that may have to cover part of the cost). I appreciate your concerns and would recommend that you contact Aetna in writing to vocalize same to verify if in fact they have hired Rawlings to perform any activity as it relates the Aetna claim.

Brittany M.:

I received this letter and filled out the questionnaire online. Oops! I had a hemorrhagic stroke due to an AVM bursting and I have been going to rehab for months to recuperate… then I received this letter. I checked the ongoing illness box but I have also applied for a critical illness stroke claim. Is there a chance that they will want that money paid back to Aetna when I had no injury or accident?

Attorney Stephen Jessup:

Brittany,

Is your Aetna policy of disability or health insurance benefits?

Netlace:

I have received three request from Rawlings for gathering key information for Cigna. My husband talked with Cigna and they said they do not use this company. They said discard it. I am concerned because after a search there are many with this same thing. This is something that needs looked into. Is this not fraud? It is signed Sincerely Cigna.

Attorney Stephen Jessup:

Netlace,

If Cigna has advised you that they have not authorized Rawlings to work on their behalf then I would not communicate with them. You may also want to file a complaint with your state insurance commissioner on account of Rawling’s actions.

Robert V.:

I have also been receiving letters from Rawlings. I have been on long term disability for 2 years having recently gone through an Aetna review of my claim. Aetna told me I still qualify for disability, then a week later the first of the Rawlings questionnaires showed up. I was injured in a fall at home, will Aetna go after my home owners insurance if I put this info on the letter?

I am with Brendan S. and also would like to know what will happen if I just ignore the letters.

Attorney Stephen Jessup:

Robert,

Aetna will certainly look to obtain the information. However, I do not know if there would be any type of subrogation right against your homeowner’s insurance for your injury. Has Aetna directly asked you questions regarding the homeowner’s insurance?

Robert V.:

Aetna has never asked any questions concerning my homeowner’s insurance or how I was injured. They have only asked questions concerning my medical eligibility.

Attorney Stephen Jessup:

Robert,

I don’t believe that they would be able to go after the homeowner’s association as the accident/injury was on account of your actions and not those of a third party. You can certainly inquire of Aetna as to who Rawlings is and why they are contacting you. Aetna may advise you to take no action with them.

Jeff:

Stephen,

I have been contacted several times by the Rawlings Company and not sure what to do. I have a bad back and subsequently had an epidural shot to help with the pain. It seems as though that playing sports and being extremely active in life has taken its toll on me but that is it. Every once in a while (like once every 5 years) it flares up and I need to get some treatment for it. Is this something that I need to disclose to them?

Attorney Stephen Jessup:

Jeff,

Is Rawlings contacting you within the context of a disability insurance claim or for purposes of health insurance?

Pat K.:

I work in HR. One of our employees received a letter from the Rawlings Company LLC with the Aetna Logo asking for a series of personal information including SSN. They threaten to deny any future claims if the form is not filled out! I scanned and sent a copy to Aetna who apparently has no idea who The Rawlings Company LLC is! I also call the number on the letter – 888-258-8060 – only to get a vague answer. In my opinion this is an attempt to defraud or gather personal information for some sort of financial gain.

In case I am wrong, however; can you please contact me and let me know if our employee is in fact obligated to fill out this form?

Thank you for your time and input.

Attorney Stephen Jessup:

Pat,

If Aetna is disavowing any knowledge of Rawlings Company as it relates to your employee I would be very hesitant to provide any information until such time Aetna directs it.

Pat K.:

Thank you Stephen. I finally spoke with someone at Aetna who confirmed that they own the Rawlings Company. I spoke with Rawlings and informed them that our employee was not covered under any other medical insurance plan and that was the end of it (the employee never had to fill out the paperwork).

Thank you for your help.
Pat

Attorney Stephen Jessup:

Pat, you are most welcome.

Kyle Valentine:

Mr. Stephen Jessup,

My wife received the Aetna/Rawlings letter asking for any information about a 3rd party. My wife has been going to a chiropractor for several months due to hip and lower back pain (possibly from being a Sous Chef and standing for 10 hours a day/ 5-6 days a week), but we have not attempted, nor intend to do any type of workman’s compensation claim or disability claim. Should we just ignore this request? It is asking us to complete the questionnaire and mail it or call Rawlings to complete it. We don’t feel comfortable authorizing ANY of her information to a third party.

Thank you in advance for your time and assistance.

Terrie:

I received one of these letters about a steroid shot for a home accident I had last year. We have insurance through Aetna, but our “company” is self-insured, essentially they only use Aetna to process the bills, so this leaves me really suspicious as it seems counter to our self-insurance. Your thoughts?

Attorney Stephen Jessup:

Kyle,

I would not suggest that you ignore the request. I would recommend you contact Aetna to first determine what the nature of the request is and express your concerns with regards to privacy. If you do not have a claim for disability or worker’s compensation then I am assuming Aetna is likely investigating based on health insurance claims and are attempting to find a way to make someone/thing else responsible for the claim.

Attorney Stephen Jessup:

Terrie,

Rawlings might be looking into whether Aetna would have subrogation rights if your homeowner’s insurance might be responsible to cover the injury. I would recommend you contact Aetna to discuss the nature of the letter and why they are sending it to you.

Alisha:

My husband received an audit letter from Rawlings from Aetna asking all sorts of questions about either of us being on long or short term disability and or receiving Medicare. I have a neurological condition and have since 2010, it is not related to a accident and isn’t anyone’s fault. I finally got disability and Medicare to help us out since I am unable to work at all… Before I received this letter they have sent me around 30 since 2010 asking if any of my claims are associated with a accident I have sent all of them in and told them it was not! But this is my first letter like this. I’m a little concerned because when my husband was in a bad car accident (at no fault of my husband’s) Aetna covered the costs of the medical expenses only to turn around and take the insurance settlement we got from the guy who hit my husband. We paid them every last bit of the settlement, we got to pay for his medical bills since it’s an ERESA insurance plan. I am really worried they will now try and make me pay for the surgeries and procedures I have got even though it has nothing to do with an injury and no one was at fault. It’s a neurological disorder I will have for the rest of my life… will they keep trying to go after me?

Is this something I need to get a lawyer about, so we aren’t constantly harassed? Do I need to fill this audit forum out? Or should I take it to someone and if so who? Or should I wait it out? They try and refuse every claim that comes their way. Right now I am in the middle of trying to get a surgery that they have denied since March (!) even though I have completed all of the criteria to get the surgery. They keep sending out the same letter requesting the same stuff that my doctor has sent in 10 times… can they keep doing this? I would rather not have to pay lawyer fees but I don’t want to get harassed over everything we go to the doctor for, either! :( It’s very frustrating to see every claim being denied, even if it was pre-authorized!

Attorney Stephen Jessup:

Alisha,

First and foremost I would contact Aetna to get clarification as to what Rawlings’ role will be in your claim. I am not sure if your concern is with respect to a health insurance policy or a disability insurance policy. If it is for the former it could be that Aetna has hired Rawlings to determine whether Medicare should have paid any of the bills.

Alisha:

The health insurance with Aetna is through my husband’s employer and he has more then 100 people at his work so medicare would be my secondary insurance. So the way everything is billed out is first Aetna then medicare. I am worried about two things, they try and get medical bills already paid for to be reversed and try and say I owe put of pocket or medicare does. Or drop me from coverage because I do have medicare now. (Since they cover a portion then it go was to medicare to cover 80% of the balance that was unapid. Also can they try and up our rates because I am getting long term disability through social security. (it has nothing to do with an accident and I never filed a claim or got an money from being hurt except for me being on disability.)

The reason I worry is from what they have done in the past. They have already sent out paper after paper asking if each claim was from an accident and I have explained it is now from any type of accident. So now I am wondering if since it’s not from a accident and I fought to get disability and fought to get medicare they will now fight to take me off the insurance or make our rates higher or even worse try and make me pay bills they already paid.

Sara:

I filed a lawsuit with an attorney after a car accident. Now the case has settled. I got a schedule of distribution of the settlement money. My attorney has listed her fees and then there is The Rawlings Co for $12,000 distribution monies. I knew nothing about the Rawlings Co. Doing the attorney’s work. Is this legal I should be paying both of them. Don’t you hire an attorney to do your subrogation?

Attorney Stephen Jessup:

Sara,

You need to discuss this situation with your attorney. Rawlings most likely worked for your healthcare provider to assert a lien on the proceeds of your settlement to pay back your insurance company for services provided in light of the accident. Most health insurance policies contain such subrogation provisions.

Add your comment

Please be advised that your comment will be public. Any information contained on our website is for informational purposes only and not legal advice. If you are seeking assistance with your claim, then please use our confidential Free Consultation form.



Your name will appear with the comment


Your email address will not be published

Please note: The comments are moderated.
Your comment will need to be approved before it will appear on this page. No off topic post will be accepted. Our attorneys may respond to your comment.

Subscribe without commenting:


Request a Free Consultation

Click here or call 800-682-8331 now!

We respond the same day.
We represent disability insurance claimants all over the United States.

Testimonials

Read what our clients say about us.

  • Ron K. I was on disability with a major insurance company for five years without any problems, upon a field rep's visit to my home, I let him know that I was planning to try to...› continue
  • O. Lee My experience with Dell & Schaefer has and continues to be, outstanding. First, I would personally like to thank Cesar for his experience and expertise in handling my...› continue
  • Wade S. My experience could not have been better. I was instantly made to feel and to know that my best interest was important, that I would be informed of all development in...› continue

More Testimonials