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 & Schaefer.