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 (http://www.diattorney.com/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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FAQ

Do you help Aetna claimants nationwide?

We represent Aetna clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Aetna disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Aetna. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Aetna.

How do you help Aetna claimants?

Our lawyers help individuals that have either purchased a Aetna long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Aetna:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Richard B.

In desperation after dealing with the insurance company by myself for a bit I called Dell & Schaefer and they listened to me then took the case. They kept me well informed as to what the law allows and what was being done. It took a bit of time but finally they got me what they could, fighting for my rights tooth and nail against a corrupt system that is in need of repair. They were always professional even when I was emotional, exultant attorney highly recommend if insurance company is running you around.

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