Aetna Denies Disability Benefits after 18 Months of Payment, but Dell & Schaefer wins ERISA Appeal

A former Safety and Training Specialist for the Dale Tile / Unilin Corporation was forced to leave work on September 16, 2010 due to his poor health. His medical conditions included chronic myotonic muscular dystrophy, osteoarthritis, systematic rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, chronic pain syndrome and chronic postrheumatic arthropathy. Although initially approved for Long Term Disability benefits, Aetna determined that after 1 year and 6 months that the individual no longer qualified under the definition of disability contained in the policy.

Aetna’s Basis for Denying the Long Tererm Disability Claim

Aetna ( based its denial of disability benefits solely upon video surveillance that was conducted over a two day period that resulted in 9 minutes and 37 seconds of video that depicted the claimant doing light yard work and riding a small motorcycle in his neighborhood. Aetna sent this video to the functional capacity examiner it had earlier hired to question whether this video would change her opinion. Earlier, this physical therapist found that the claimant’s physical demand level was “less than sedentary.” After viewing Aetna’s video, the physical therapist changed her opinion and found that the claimant was “capable of at least light duty capacity on a full time basis.”

Claimant Contacts Disability Attorneys Dell and Schaefer

Within hours of receiving the long term disability denial letter from Aetna, the claimant contacted Attorneys Dell and Schaefer. The claimant’s quick call to our firm provided Attorney Alexander Palamara maximum time to assess the claim, gather information and determine an ultimately successful plan of attack. This was extremely helpful as an administrative appeal must be filed within 180 days of receipt of the denial letter. If an appeal is not filed within that time period, rights to the policy and claim may be lost forever.

Administrative ERISA Appeal of Aetna Disability Denial

Attorney Alexander Palamara timely appealed Aetna’s decision to deny the client’s claim. The strength of the client’s medical records and the support from each of the treating physicians was more than enough to convince Aetna that its decision to deny benefits was incorrect. Furthermore, the fact that Aetna’s hired physical therapist who conducted the earlier Functional Capacity Evaluation was so easily convinced to change her earlier opinion with 9 minutes of video following her day long testing called into question her capabilities as a reviewing therapist or the reliability of her functional capacity evaluations. As such, Attorneys Dell and Schaefer were able to debase all the evidence Aetna relied upon in denying the client’s claim. Aetna overturned its decision to deny benefits with 45 days and the client is currently back on claim and he receiving his benefits each month.

Our law firm has handled hundred of ERISA appeals against Aetna and we represent claimants nationwide. Contact us for a free consultation to discuss your disability claim.

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