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

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.


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Aetna Reviews
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Aetna

Aetna STD has been a nightmare since the beginning

Reviewed by Michael S. on May 13th 2020   Verified Policyholder
I had surgery on 2/27/2020. Aetna STD has been a nightmare since the beginning. Total mismanagement of everything. I have never been paid consistently & have had to manage... read more >
Reply
Sent on May 13th 2020 by Attorney Jay Symonds

Michael: Generally speaking Hartford now manages the Aetna claims. The timing of STD claims is difficult because the benefit is a week to week benefit but the medical i... read more >

Aetna

Aetna leaves me at risk of losing my job and without compension

Reviewed by Amber P. on March 6th 2020   Verified Policyholder
I applied for STD 2/24/2020 for eye surgery. Documents were submitted. Aetna noted they contacted the doctor and needed the APS form; already was submitted. So, the dr sub... read more >
Aetna

Aetna puts their clients through hell with their games

Reviewed by Joe Doe on April 19th 2019   Verified Policyholder
I have been on Aetna disability for a couple of years now and have surround sound to be extremely cunning and ruthless. They put put claimants through hell for the first 6... read more >
Reply
Sent on April 19th 2019 by Attorney Jay Symonds

Joe, you make an excellent point. If a claimant has questions or concerns regarding the treatment they are receiving during the claims process it is wise to contact cou... read more >

Aetna

It's been over 3 months, and I've only received one payment from Aetna

Reviewed by Crystal A. on January 24th 2018   Verified Policyholder
I have been struggling with Aetna to get my short term disability, its been since 10/16/2017 and I have only received one payment since. My doctors send in my forms and th... read more >
Reply
Sent on January 24th 2018 by Attorney Stephen Jessup

Crystal, Aetna should have rendered a final decision on your claim well over a month ago. Please feel free to contact our office to discuss your situation to best deter... read more >

Aetna

Aetna people are thieves, crooks and liars.

Reviewed by Anonymous on August 23rd 2017   Verified Policyholder
It is my opinion that Aetna people are thieves, crooks and liars. I purchased a disability policy from my employer with Aetna. I became disabled because of a heart conditi... read more >
Aetna

Aetna is definitely committing a crime and they need to be stopped.

Reviewed by on April 8th 2017   Verified Policyholder
Aetna denied my claim after providing all my doctor notes 5 times, all my ER records. stating that i did not see my doctor until 3/3/17 but my out of work date was 2/16/17... read more >
Reply
Sent on April 8th 2017 by Attorney Stephen Jessup

Sarah, as your claim has been denied your next step is to file your administrative appeal. As Aetna typically only allows for one level of appeal before a lawsuit must ... read more >

Aetna

I hate Aetna

Reviewed by Pamela L. on April 7th 2017   Verified Policyholder
My story is the same as most here. I suffer from several afflictions. T1 diabetic for 42 years, stage 3 kidney disease, neuropathy pain in feet legs and hands, carpal tunn... read more >
Reply
Sent on April 7th 2017 by Attorney Stephen Jessup

Pamela, what is the current status of your claim with Aetna? Please feel free to contact our office to discuss what options/rights you may still have against Aetna.

... read more >
Aetna

Aetna denied me and then I got fired from my job

Reviewed by Jeremy on April 3rd 2017   Verified Policyholder
I got denied and got fired right after my Dr submitted my paperwork for leave, due to being in the hospital. They fired me for being in the hospital. and now paying unempl... read more >
Reply
Sent on April 3rd 2017 by Attorney Stephen Jessup

Jeremy, when was your claim denied? Did you file an appeal? Please feel free to contact our office to discuss the denial of benefits to determine what rights you may ha... read more >

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Q: What can I do to stop Aetna from harassing me and realize that not all disabilities are the same?

Answered on May 3rd 2017 by Attorney Stephen Jessup
A: SO, it certainly sounds the Aetna is setting your claim up for a denial. Please feel free to contact your offi... Read More >

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