Aetna denial of long-term disability benefits for chronic fatigue syndrome upheld by Court

Physician’s Failure to Fill Out Functional Limitations Paperwork Costs Man Rightful Benefits

A supporting physician is essential for any claimant to receive long-term disability benefits. However, a treating physician must do far more than just diagnosis a disabling medical condition. The decision rendered by the U.S. Court of Appeals, Seventh Circuit in Williams v. Aetna Life Insurance Company continues to have an impact on long-term disability decisions in U.S. Courts even though it has been over two years since Lee K. Williams lost his appeal against Aetna Life Insurance Company (Aetna) and The Sysco Corporation Group Benefit Plan (Plan). Williams’ unsuccessful attempt to secure a Court reversal of his long-term disability denial for chronic fatigue syndrome (CFS) continues to shape the strategies of disability attorneys as they help their clients perfect their claims for this non-objective ailment.

Williams, who was 48 at the time of the court decision, had been a truck driver for Sysco since November 1994 until his CFS made it too exhausting to continue working on July 26, 2002. His job wasn’t completely sedentary. Despite the fact that he spent many hours on the road, he helped unload the deliveries. This meant he might have to lift 100 lbs., climb ladders, kneel, twist and stoop for up to two hours of his day. Aetna considered these occasional work responsibilities. He spent up to another four hours of the day lifting up to 50 lbs., climbing stairs, pushing, pulling, reaching, grasping, sitting, standing, walking, and using his fine and gross manipulations skills. Aetna considered these frequent job required tasks. Finally, the continuous job requirements, which could occur throughout his eight-hour day, included lifting up to 20 lbs., carrying up to this amount of weight and bending.

As a participant in the Sysco Corporation Group Benefit Plan, Williams expected to be able to collect benefits after he became ill on July 26, 2002 and had to be admitted to the hospital for his symptoms – fatigue, shortness of breath, dizziness and cough. Even after his release, his symptoms continued, so he underwent a series of tests to determine the cause of his symptoms. Dr. John Sorin, an immunology and CFS specialist at Northwestern Hospital, ruled out other conditions before he reached the conclusion that Williams had CFS.

In February 2003, Williams applied for long-term disability benefits under the Aetna Disability Plan. Dr. Sorin submitted an Attending Physician Statement informing Aetna that Williams had been diagnosed with CFS. Dr. Sorin expressed his opinion that Williams had a Class 5 impairment – unable to perform even minimal sedentary activities.

Aetna asked Sysco, in March 2003, to provide a physical demands analysis for Williams’ truck driving position. Armed with this information, Aetna sent Williams’ application to Dr. Brent Burton for review. Dr. Burton’s evaluation stated that the medical data in the file failed to provide documentation that Williams had a diagnosable medical condition that accounted for his subjective symptoms of fatigue. The data from physical examinations showed no evidence that Williams had lost his range of motion, strength, coordination or ability to feel. Dr. Burton also found that none of the information in the file indicated that Williams’ impairment was significant enough to prevent him for working as a truck driver.

On May 12, 2003, Aetna notified Williams that the disability insurance plan was denying his claim because to quote Dr. Burton “[T]he medical data in this case do not provide any documentation that Mr. Williams has a diagnosable medical condition that explains his subjective symptom of fatigue. The physical examination data do not reveal evidence of significant loss of range of motion, strength, sensation, coordination, etc., to justify discontinuation of workplace activities. There is no data to indicate that Mr. Williams has sufficient impairment to render him unable to work in his usual occupation as a truck driver.”

Physician fails to complete residual functional capacity questionnaire completely.

Williams appealed Aetna’s decision. Dr. Sorin sent the long-term disability Plan administrator a note on May 19, 2003 stating that he was treating Williams for CFS. In his opinion, even though Williams was showing signs of improvement, the truck driver was still unable to resume work. Aetna asked the doctor to fill out a CFS residual functional capacity questionnaire. Dr. Sorin returned the questionnaire on August 11, 2003, but it was not filled out completely.

While Dr. Sorin did fill out the section dealing with how Williams’ fatigue constantly interfered with his ability to concentrate and focus, he failed to provide explanations to support some of the other conclusions he had drawn. When asked to provide his estimate for how long Williams could perform certain activities, he provided partial answers. For example, when asked how many hours Williams could sit or stand at one time, the doctor wrote “unknown” in the margin. He stated that Williams could lift 10 lbs. occasionally, but failed to indicate if he could lift any higher weights. He stated that Williams had significant limitations when repetitive reaching, handling and fingering were involved, then later stated that he had not tested Williams to evaluate how long Williams would be able to perform these activities each day.

Disability attorney files ERISA appeal of Aetna disability denial decision.

Williams’ disability attorney wrote a formal appeal letter to the disability insurance company on September 10, 2003. Aetna upheld its denial of disability benefits on January 9, 2004, after considering the additional information supplied by Dr. Sorin. The denial pointed specifically to the Dr. Sorin’s report that had stated several times that Williams had not been tested for functional limitations for the very activities he was claiming he could no longer perform. The disability insurance Plan stated clearly that without this evidence, Aetna could not reverse its decision. His file was closed. Williams’ attorney should have considered having his client undergo a functional capacity evaluation.

Disability attorney advises Aetna that his client was approved for SSDI and files ERISA lawsuit

On July 28, 2004, the disability attorney requested a copy of Williams’ claim file. He also notified Aetna that the Social Security Administration had deemed Williams disabled. When this information failed to prompt Aetna to reverse its denial of benefits, Williams filed suit against Aetna and the Plan under the Employee Retirement Income Security Act (ERISA) section § 1132(a)(1)(8). The District Court ruled in favor of Aetna and the Plan on September 28, 2004.

Disability attorney files appeal of District Court decision.

Williams’ disability attorney filed an appeal with the U.S. Court of Appeals, Seventh Circuit. In evaluating the correctness of the District Court’s decision, the judges hearing arguments had to follow carefully the guidelines established by ERISA. Because the long-term disability Plan gave Aetna discretion to determine whether Williams was eligible for benefits and to interpret the terms of the Plan, the Court of Appeals had to consider Aetna’s decision under the arbitrary and capricious standard, just as the District Court had. The judges also could only listen to arguments that had been presented before the District Court.

Because Aetna’s decision fell under the arbitrary and capricious yardstick, the Court only had to determine whether Aetna’s decision was reasonable in light of the evidence in the records kept of Williams’ claim. His disability attorney argued that Aetna’s decision was not supported by the record.

  • The disability attorney claimed that the Plan had denied Williams’ application because his subjective symptoms of fatigue could not be confirmed by medical diagnosis. This was in direct violation of the findings of Hawkins v. First Union Corp. Long-term Disability Plan. The Court found that after Williams’ appeal, Aetna agreed that he did indeed have CFS, but upheld its denial of benefits based upon the lack of evidence supporting how much the CFS impacted his functional abilities.
  • The disability attorney argued that Aetna’s use of Dr. Sorin’s incomplete questionnaire as reason to deny benefits was arbitrary and capricious. The Court found otherwise. Because Dr. Sorin failed to explain how he could determine that Williams had significant functional limitations when he wrote “unknown” and “untested” as an answer to different questions designed to evaluate the performance abilities of his patient, the Court found that his entire evaluation failed the test of credibility. The Plan’s denial of benefits based upon Dr. Sorin’s failure to provide clear and accurate information could not be faulted.
  • The disability attorney alleged that Aetna had denied Williams a full and fair review. The Court disagreed. While the Court would have preferred that the final denial letter had not quoted Aetna’s physician’s conclusions verbatim, the denial letter still contained a sufficient summary of the other information in Williams’ file and a reasonable breakdown of the reasons the claim was being denied – including the fact that Dr. Sorin’s questionnaire failed to support Williams’ disability.
  • The disability attorney claimed that Aetna’s refusal to give credit to Dr. Sorin’s findings demonstrated an arbitrary and capricious decision by the disability insurance company. The Court refused to fault Aetna’s conclusion that Dr. Sorin had failed to provide sufficient support for Williams’ functional restrictions.
  • The disability attorney argued that Aetna had violated its own internal procedures when it failed to obtain additional medical information when Dr. Sorin’s findings and Dr. Burton’s conclusions differed. The Court also found this argument meritless. While the two reports disagreed on the CFS diagnosis, the denial was not based on this fact, but on the lack of proof that Williams was functionally impaired.
  • The disability attorney alleged that Dr. Burton’s opinion was inherently biased and unreliable because he was the Plan’s medical consultant, making Dr. Sorin’s opinion of greater weight. The Court looked to Black & Decker Disability Plan v. Nord, where the Court expressly held that plan administrators are not obliged to accord special deference to the opinions of treating physicians, and Davis v. Unum Life Ins. Co., where the Court refused to consider the argument that in-house doctors have an inherent conflict of interest. The Court also found Dr. Sorin’s report failed to demonstrate internal reliability.
  • Finally, the disability attorney argued that Aetna had failed to credit the Social Security’s determination that Williams was disabled by his CFS. The Court recognized the differences between Social Security Disability and ERISA benefit plans and found the argument without merit because Aetna did not require Williams to apply for Social Security disability benefits in order to retain his rights to long-term disability benefits under the Plan.

In conclusion, the Court found that Williams’ disability attorney had failed to present any arguments that proved Aetna had made an arbitrary and capricious disability benefits denial. The Court of Appeals affirmed the decision of the District Court and granted summary judgment in favor of the Sysco Corp. Group Benefit Plan.

The primary lesson to be learned from this case is the value of medical information that clearly supports a disability attorney’s client’s disability claim. Treating physicians are not trained to answer insurance company medical questionnaires. A treating physician’s failure to document restrictions and limitations will always jeopardize a claimant’s disability claim. The insurance company are trained that diagnosis does not mean disability. As result, a claimant’s medical records must clearly document restrictions and limitations. If an experienced disability attorney becomes involved in a claim he/she should be able to identify this type of issue, and possibly save his/her client from a long, yet unsuccessful legal process.


Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Appeal Package

We work with you, your doctors, and other experts to submit a very strong appeal.

Learn more

Sue Your Disability Insurance Company

We have filed thousands of disability denial lawsuits in federal Courts nationwide.

Learn more

Protect Your Benefits
Get Your Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Aetna Reviews
(648)

Policy Holder Rating

1.6 out of 5
Read 53 reviews
0%would recommend
5
0%
4
0%
3
0%
2
62%
1
37%
Timely Payments
1.9out of 5
Handling Claim
1.9out of 5
Customer Service
2.0out of 5
Dependable
2.1out of 5
Value
2.1out of 5
Showing 8 of 648 Reviews
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 >

Answered Questions by Our Lawyers
(30)
Showing 8 of 30 Answered Questions

Q: Can Aetna deny my application on the basis of pre-exisiting condition? Do they discriminate against the mentally ill?

Answered on September 2nd 2020 by Attorney Steven Dell
A: Molly, unlike health insurance plans, a disability insurance carrier can deny application for coverage based o... Read More >

Q: Are there any circumstances in which I can appeal LTD after the number of days Aetna gives you to appeal?

Answered on April 3rd 2019 by Attorney Rachel Alters
A: Sharon, usually the insurance carriers are pretty strict and adhere to the appeal deadline which is set out in... Read More >

Q: Can Aetna deny my claim due to a "war exclusion" on my policy?

Answered on January 22nd 2019 by Attorney Stephen Jessup
A: Phil, I am sorry to hear about your difficulties. Have you filed an appeal of the denial? All disability insur... Read More >

Q: What do I do if Aetna claims they haven't received my medical info?

Answered on December 7th 2018 by Attorney Gregory Dell
A: Roberta, you should contact Aetna to verify that they actually received the information and find out if they a... Read More >

Q: How can Aetna say I am not disabled when clearly I am?

Answered on October 18th 2018 by Attorney Rachel Alters
A: Laurie, unfortunately Aetna can hire their own doctors to disagree with yours and claim you can work even if y... Read More >

Q: Is the 2nd appeal process worth it or a waste of my time?

Answered on October 3rd 2017 by Attorney Stephen Jessup
A: Rebecca, I would certainly say it is worth it. If he filed for disability in September 2016 and the change in ... Read More >

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 >

Q:  Can Aetna deny my claim for STD due to pregnancy because it was preexisting?

Answered on February 2nd 2017 by Attorney Stephen Jessup
A: Slavka, unfortunately, disability insurance policies come with pre-existing condition provisions that are enfo... Read More >
Helpful Videos
(896)
Showing 12 of 896 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips

Does Social Security Approval Mean Disability Insurance Benefits Will Be Paid?

The answer to this question is NO and a recent case brought by a FEDEX employee against Aetna insurance company is an example of an SSDI approval and a long term disability denial. In a recent case, a Fed-Ex employee filed a lawsuit against AETNA following the denial of long term disability benefits. Aetna paid long-term disability benefits for 24 months and then denied benefits when his definition of disabili... Read More >

Does a disability insurance company need to consider the side effects of my medications?

Disability insurance companies are notorious for ignoring the cognitive side effects that most disability claimants experience from their medications. Disability companies are aware of the side effects of narcotics; yet they often fail to consider how working under the influence of these prescribed drugs limits a person's ability to work. Disability benefit comp... Read More >

Does the Mental Nervous Disorder Limitation in an ERISA Long Term Disability Plan Violate ADA Laws?

According to several Federal district courts throughout the country the answer to this question has historically been that the American with Disability Act (ADA) laws does not apply to an ERISA long term disability policy provided by an Employer. The reason the ADA has been found not to apply is because of a concept called ERISA Preemption. ERISA Preemption means that since ERISA is a Federal law it overrules ... Read More >

Is it legal to limit disability insurance benefits to 24 months for mental nervous claims?

The question listed below was recently posted on our disability blog, but since it is a question that we receive on a weekly basis, we decided to make it a frequently asked question.Thank you so much for this blog and your site. It is truly a resource for anyone with an ERISA claim.From the start things are skewed when you have a "mental health" diagnosis. The inequities the mental health community has had... Read More >

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases

Aetna Overturns Denial of Long Term Disability Benefits for Quality Control Manager

Our client, Mr. J, formerly worked as a Quality Control Manager for a large home furnishings store. For many years Mr. J suffered from the debilitating effects of his chronic, organic medical conditions and associated cognitive deficits, including transient cerebral ischemia and chronic migraines, which left him with significant physical and cognitive impairments. As a result of his serious medical conditions ... Read More >

Aetna Removes 24 Month Limitation for Mental Health Conditions

For nearly six years, Attorney Stephen Jessup has been representing our client, a former chief in-house counsel in charge of compliance and regulations for a large corporation. When she first contacted our office and spoke with Attorney Jessup, Aetna had already been challenging her disability due in large part to what Attorney Jessup believed was on account of the large monthly disability benefit Aetna was pa... Read More >

Aetna Overturns Denial of LTD for Former Employee of The Home Depot

Prior to enlisting our services to challenge a denial, our client had received benefits from Aetna due to his disabling conditions for 18 months. Unfortunately for our client, Aetna decided to deny benefits due to the “change in definition of disability.”Common in most group disability insurance policies, the change in definition typically happens after benefits have been paid for 18 or 24 months. For ... Read More >

Aetna Reinstates Benefits for Former SAP America Employee Suffering the Effects of a Head Injury

My now client worked for SAP America, Inc. as a Senior Solutions Sales Executive for nearly seven years. She made a great salary working at a job and employer she loved. Her work required superior cognitive and analytical skills and was both challenging and rewarding. Unfortunately for her, in December of 2016, she suffered a serious head injury. While she attempted to remain working, as of January 2017 her sy... Read More >

Aetna overturned previous denial of long term disability benefits for Georgia Assistant

Our client, Ms. A, formerly worked as an executive assistant for a town administrator. In April 2014 a number of co-morbid physical conditions and ailments forced Ms. A to stop working and submit her claim for disability benefits under her employer’s Long-Term Disability (“LTD”) Policy which was administered and funded by Aetna. Under the employer’s disability policy Ms. A would be considered totally d... Read More >

Dell Disability Lawyers file Lawsuit in Federal Court against Aetna after it denied long-term disability benefits to former software Developer

In 2011, while working as a software developer for a different company, Charles suffered a cerebral vascular attack (CVA). Despite suffering a stroke, after a period of recovery, Charles returned to work, but for a different employer. In 2014 Charles migraines increased and he began having significant problems with his short-term and long-term memory. He also found that he was having significant difficulty per... Read More >

After Aetna denied Ms. Garner's long-term disability claim, Ms. Garner filed suit against Aetna, and the Court overturned Aetna's decision and ordered it to pay Ms. Garner's disability benefits

In 2004, Sally took a leave of absence from her job as an import supervisor for a global shipping company to undergo surgery for an internal left knee derangement. During that time she had also been suffering from severe symptoms of depression following her son’s departure to college and the at-home environment changing. Her doctors diagnosed her with bipolar disorder II and placed her on depression and anxi... Read More >

Aetna Reinstates Disability Insurance Benefits to Home Depot Manager

Prior to disability our client worked as a Warehouse Distribution Operations Manager for Home Depot, a job that not only required supervision of employees, but a significant amount of physical ability. However, a long fight with uncontrolled diabetes and severe diabetic neuropathy reached a point where he was no longer able to meet the physical demands of his occupation leaving him with little choice but to fi... Read More >
Disability Lawsuit Stories
(765)
Showing 8 of 765 Lawsuit Stories

Court Ordered Aetna to Pay LTD Benefits to Computer Engineer

In Darren Cohen v. Aetna Life Insurance Company [Aetna], Plaintiff was employed by STEC, Inc. as a Computer Systems Engineer where he worked on his computer for 6-8 hours a day. STEC, Inc. is a computer data storage technology company.Plaintiff was injured while driving a Go-Kart at an employer-sponsored event. He suffered a traumatic brain injury (TBI) and spinal cord compression. He had pre-exi... Read More >

Court Orders Aetna to Pay LTD Benefits to Plaintiff Suffering from CFS

In Nancy Devries v. Aetna Life Insurance Company (Aetna) plaintiff worked as First American as a Senior Business Analyst until August 19, 2016. On that day, she stopped working. A few days later, she filed a claim for short term disability (STD) benefits.Plaintiff was under continuous care of her primary care physician, an immunologist, and a physician’s assistant (PA). She had freque... Read More >

Court Upholds Aetna’s Denial of LTD Benefits Under the “Any Occupation” Disability Definition

In Tanza Hadd v. Aetna Life Insurance Company, Plaintiff Hadd, was employed by UPS as an Operations Supervisor/Manager, also known as a Hub Supervisor. The job was classified as “heavy” and involved moving packages of up to 150 pounds. The working environment was filled with dust and dirt and kept at various temperatures. Plaintiff stopped working in April 2013.Plaintiff w... Read More >

A Judge’s 8 Reasons that Aetna Reasonably Denied Disability Benefits to Bank of America Employee

In Claire Refaey v. Aetna Life Insurance Company, in late September 2015, Plaintiff suffered from a viral disease causing quite a few medical symptoms including nausea, abdominal pain, diarrhea, weakness in her extremities, hypotension, and inability to walk. She was hospitalized and treated symptomatically. She was released from the hospital on October 2, 2015 and referred for ou... Read More >

Court Rules That Aetna’s Failure To Consider Plaintiff’s Actual Job Duties Was Arbitrary And Capricious

Aetna’s Rationale for DenialIn Patterson v. Aetna Life Insurance Company, C.A. No. 17-3566 (3rd Cir. 2019) through his employer, First Consulting Group, Inc. (“FCG”), is a pharmaceutical consulting firm, Patterson became covered by a long-term disability policy underwritten by Aetna. Patterson’s occupation with FCG was characterized as “Director, Busin... Read More >

Court Upholds Aetna’s Denial of Accidental Death Benefits Under Intoxication Exclusion

In Jordan Harper v. Aetna Life Insurance Company, (Aetna), Plaintiff’s husband, Douglas Harper, died on December 31, 2017, in a single car accident to which there were no witnesses. The accident report noted there were no skid marks or any indication the driver of the car took any evasive action. The death certificate showed the cause of death as “multiple blunt force injuries.... Read More >

1st Circuit Affirms Holding That Claim Is Not Subject To Pre-Existing Condition Provision

In Lavery v. Restoration Hardware Long Term Disability Benefits Plan, 2019 WL 4155038 (1st Cir. September 3, 2019), Plaintiff John Lavery ("Lavery"), who was disabled following a diagnosis of malignant melanoma, brought claims under the Employee Retirement Income Security Act ("ERISA") against Defendants Restoration Hardware Long Term Disability Benefits Plan ("the Plan") and Aetna Life Insurance Company ("Aet... Read More >

If Your Long Term Disability Claim is Denied due to a Pre-Existing Condition, All May Not be Lost

In a recent case out of Massachusetts, a Court sided with a disabled claimant and found that Aetna’s decision to deny the claim for benefits was wrong. Aetna justified its denial as it believed the disabling medical condition to be a “pre-existing” condition and the policy governing this claim, like most Long Term Disability (“LTD”) policies, contained a provision that states that benefits will not b... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our attorneys for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We offer disability insurance attorney representation nationwide and we welcome you to contact any of our lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 850 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

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 insurance 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 phone, email, fax, or video conferencing sessions. 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 insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.

Helpful Resources