Dell Disability Lawyers ERISA Administrative Appeal Successful: Claimant suffering from Sleep Disorders, Depression and Fibromyalgia Now Receiving Long Term Disability Benefits
Attorney Alexander Palamara of Dell Disability Lawyers is happy to report of another client’s approval for Long Term Disability (LTD) benefits by Aetna. Our client previously worked as a Nurse for the Lee Memorial Health System in Florida since 2001. Unfortunately for our client, she began to suffer from the following medical conditions: Narcolepsy with Cataplexy; Severe Obstructive Sleep Apnea; Insomnia; Hypersomnia; Sleep Paralysis; Chronic Fatigue; Dizziness, Major Depression, Recurrent Episode, Severe; Post Traumatic Stress Disorder; Bipolar Disorder; Morbid Obesity, in partial remission; Peri-Menopause; and Fibromyalgia. These conditions left her unable to perform the material duties of her own occupation.
Fortunately for our client, working for Lee Memorial Health System provided her with Long Term Disability Insurance Coverage for such a situation. Our client was forced to leave work in early April 2014 and filed a claim for LTD benefits by herself shortly thereafter.
Claim Initially Denied
Unfortunately for our client, Aetna Life Insurance Company, the Long Term Disability Claim Administrator and Payer of Benefits, denied her claim by way of a denial letter dated July 18, 2014. In its denial letter, Aetna ultimately concluded that our client was not disabled as defined by the policy as of July 17, 2014, the date benefits should of begun. Aetna stated that the clinical information it had on file was “insufficient to support the presence of a functional impairment from a physical or mental perspective… and therefore we find that you do not meet the definition of disability…”. In support of its contention, Aetna relied upon a clinical review by one of its employees and a “medical peer review.” Within a few days of receiving the denial letter from Aetna, the claimant found us and quickly became a client of Dell Disability Lawyers.
Administrative Appeal filed by Dell Disability Lawyers
After reviewing the Administrative Record provided by Aetna, as well as the medical records of the client, it was apparent to us that Aetna’s decision was blatantly incorrect, as well as arbitrary & capricious. Furthermore, the “reviews” that Aetna relied upon were not found in the complete administrative record provided to us. Needless to say, those reviews were misguided at best.
Our client’s medical records and the support of her treating physicians were overwhelming. Furthermore, prior to the time that we filed an administrative appeal, our client was approved for Social Security Disability Benefits. Armed with the above, an administrative appeal was timely filed which challenged Aetna’s denial of her claim.
Within 5 weeks of the filing of the administrative appeal, Aetna sent a letter stating that our client’s claim had been re-opened for benefit payments. Thus Aetna has agreed with our contention that our client is unable to perform the material duties of her own occupation. The back benefits owed to her will be paid shortly and our client will be receiving a monthly benefit for the time being and hopefully the long future.
Though our client is back on claim, she knows the fight does not end. After 24 months of benefits, it typically becomes more difficult to stay approved under most LTD Group ERISA policies. This is due to the change in definition of disability. At that point, the client will have to prove that she is “unable to work at any reasonable occupation.” Though the change in definition of disability is not close to occurring, the attorneys at Dell Disability Lawyers will continue to fight to ensure that Aetna does not deny her claim now or in the future.
If you have been denied Long Term Disability Benefits by Aetna or any other insurance provider, please do not hesitate to contact Dell Disability Lawyers for a free consultation.
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Q: Can Aetna deny my application on the basis of pre-exisiting condition? Do they discriminate against the mentally ill?
Q: Are there any circumstances in which I can appeal LTD after the number of days Aetna gives you to appeal?
Q: What can I do to stop Aetna from harassing me and realize that not all disabilities are the same?
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Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.