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-existing neck and upper extremity conditions that were exacerbated by the accident.

Plaintiff was off work for 18 months before returning for only 20 hours a week. He received long-term disability (LTD) benefits for 24 months when Aetna agreed he was unable to perform the duties of his own occupation or could only perform those duties with restrictions.

After 24 months, the definition of disability changed to requiring Plaintiff to prove he was unable to work at “any reasonable occupation” which was defined as “any gainful activity for which you are; or may reasonably become, fitted by education; training; or experience.”

Aetna then conducted surveillance on Plaintiff and performed “a paper review of his claims.” Based on the paper review, on December 6, 2011, Aetna informed Plaintiff his benefits were terminated because it believed he could work full time. Plaintiff appealed and the denial of benefits was overturned in March 2012.

In October 2012, April 2013, October 2014, Aetna reviewed Plaintiff’s medical situation and determined he was still unable to perform the duties of “any reasonable occupation.”

In July and August 2015, Aetna again ordered surveillance which occurred over several days. In September 2016, Aetna’s vocational consultant reported that it would be difficult to find a job Plaintiff could do.

In June 2017, for a third time, Aetna ordered surveillance of Plaintiff. Aetna characterized Plaintiff on the video as “very active” and that “he was performing activities that he should avoid,” so it ordered him to undergo an Independent Medical Exam (IME). A paper review of his medical records was again conducted. Based on these reports, on July 25, 2018, Aetna terminated Plaintiff’s LTD benefits. Aetna then informed Plaintiff he had the right to an administrative appeal.

The Administrative Appeal

Following the disability insurance claim denial, Plaintiff filed an administrative appeal where he submitted updated medical records, including MRI results, his own vocational analysis performed in February 2019, and physician statements. All confirmed their opinions that Plaintiff was unable to work in any reasonable occupation.

Aetna commissioned two more paper reviews of Plaintiff’s medical records. When Aetna was unhappy with one of the reports, it sent it back to the doctor and asked him to “amend” his findings. The second report supported Aetna’s view that Plaintiff could perform a full-time job with some restrictions.

On appeal, Aetna again issued its disability insurance denial. Having exhausted his administrative remedies, Plaintiff filed this ERISA lawsuit in the U.S. District Court for the Central District of California.

District Court’s Conclusion

After reviewing all the evidence presented by both Plaintiff and Defendant, and conducing de novo review, the Court found in favor of Plaintiff and stated:

The Court, reviewing all of the medical evidence on the record, finds that Plaintiff has shown by a preponderance of the evidence that he suffers from conditions that result in a loss of functionality that require restrictions that severely limit his ability to work and more likely than not require a maximum of four hours of work a day. These restrictions were approved by several of Cohen’s physicians and at least one of Aetna’s physicians. In the Ninth Circuit, ‘an employee who cannot sit for more than four hours in an eight-hour workday cannot perform ‘sedentary’ work that requires ‘sitting most of the time.’ [citation omitted.] Thus, the Court finds that these restrictions mean that Cohen would be unable to work at “any gainful activity for which experience.

Medical Evidence Supported Plaintiff’s Claim for His Disability Insurance Benefit

The Court noted that In an ERISA appeal, “it is a claimant’s burden to prove he is entitled to benefits by a preponderance of the evidence.” In finding that Plaintiff met that burden, the Court noted that even one of Aetna’s own reviewing physicians concluded that Plaintiff could not type more than 15 minutes at a time and would need to take frequent breaks throughout the workday.

The Court also commented that one of Aetna’s physicians only conducted an “8-minute physical examination” and concluded that all Plaintiff needed was an ergonomic work station with frequent breaks. The doctor did not review certain reports the Court found relevant. Another Aetna doctor simply opined that Plaintiff could work a regular work week and a third one changed his report after Aetna sent him a letter asking him to correct his report.

The Court discounted these reports of Aetna’s physicians because “Plaintiff has provided enough evidence to rebut those opinions through doctor’s visits, reports, and recommendations from 2008 to as recent as January 2019. This is enough to meet [Plaintiff’s] burden.”

Court Found Video Surveillance Did Not Rebut the Medical Evidence

In contrast to the way Aetna characterized the video surveillance, the Court reviewed it and determined it did not rebut the medical evidence in the Administrative Record that compels this Court’s findings. As noted above, the footage largely shows [Plaintiff] performing routine acts of life that do not contradict the findings of the medical professionals outline above. Indeed, even the recording of [Plaintiff’s] light jog does not persuade the Court that his medically reasonable restrictions are not supported by the record. To the extent that Aetna argues otherwise, they overstate the importance of this evidence.

The Court concluded “that Plaintiff shall be awarded past-due benefits and pre-judgment interest through the relevant period under the Policy…Plaintiff’s LTD benefits are hereby reinstated going forward.”

This case was not handled by our firm, but we believe it can be instructive to any who are struggling with a denied disability claim. No matter what stage you are at with your claim for either LTD or short-term disability benefits, contact a disability attorney at Dell & Schaefer. We will review your policy and your situation and discuss with you how we can help.


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
(642)

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 642 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
(888)
Showing 12 of 888 Videos
Disability Benefit Tips
(330)
Showing 8 of 330 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 appro... 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 mos... 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 D... 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... 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 concern... Read More >

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

When you're seeking disability benefits under a long term disability policy, your medical rec... Read More >

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

One thing many long term disability claimants don't know about (or expect) from the claims re... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults... 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 deb... 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 re... 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 mont... 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 ... 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... 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... 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 ... 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 h... 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 u... 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/M... 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 cau... 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&nb... 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, 201... 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 ("La... 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... 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 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 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 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 lawyers 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 lawyers 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 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 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 lawyers 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 lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our 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 welcome you to contact any of our attorneys 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 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers 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 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, GoToMeeting 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 800-698-9159 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.