Nevada disability lawyer and COX Enterprises Inc's customer service rep sue AETNA for denial of disability benefits

A former Customer Service Representative (CSR) for COX Enterprises Inc. (COX) recently filed a lawsuit through a Nevada disability attorney against the AETNA Life Insurance Company (AETNA Life) at the District Court for the District Court of Nevada. In Sandra Rada v Cox Enterprises Inc as Plan Administrator & AETNA Life Insurance Company as Claims Administrator, the plaintiff Sandra Rada alleged that AETNA Life had not provided the plaintiff with a full and fair review of her claim for long term disability (LTD) benefits and thus seek the Court to review Aetna Life’s decision under a de novo standard.

Aetna Disability Claim Denial History

The plaintiff, beginning January 1st 2005, was employed as a CSR with COX. Her duties as a CSR among other things included handling incoming customer calls; introducing and selling new or additional products or services; reviewing customer inquiries/problems and determining an appropriate solution or response; negotiating customer claims; initiating billing adjustments; arranging product substitution or returns; assessing customer needs; processing incoming orders; and providing clerical/administrative support to the customer service functions. As an employee of COX, the plaintiff participated in a Welfare Benefits Plan (which included a LTD flex plan) that was sponsored by COX. The Welfare Benefits plan also designated AETNA Life as the Claims Administrator.

On March 13th 2008, the plaintiff was involved in a motor vehicle accident. As a result of the accident, she sustained head trauma, scalp laceration which required 30 stitches, multiple contusions and injuries to the back and neck. Since the March 13th accident, the plaintiff alleged that she suffered from post-concussive syndrome which included anxiety, depression, headaches, memory loss, difficulty concentrating, word-finding problems, sleep disturbance, confusion and fatigue. Prior to the March 13th accident, the plaintiff also had a history of chronic back and neck pain due to two previous motor vehicle accidents. She was already having medical treatment for these past injuries when the March 13th accident aggravated her condition.

Definition of ‘Total Disability’ under the Aetna Disability Plan

Under the Welfare Benefits plan that the plaintiff participated in, the plan defined total disability as:

In the first 24 months of a period of total disability: You are not able, solely because of injury or disease, to work at your own occupation.

After the first 24 months of a period of total disability: You are not able, solely because of injury or disease, to work at any reasonable occupation. (This is any gainful activity for which you are, or may reasonably become, fitted by education, training or experience. It does not include work under an approved rehabilitation program.)

Due to her medical conditions, the plaintiff applied for long term disability benefits under the above mentioned plan in August 2008. The claim was approved and AETNA Life paid LTD benefits to the plaintiff from September 14th 2008 through April 9th 2010. Concurrently, the plaintiff also applied for social security disability benefits which was approved and awarded to the plaintiff on January 22nd 2010 by the Social Security Administration (SSA). In its determination, the SSA deemed the plaintiff as being disabled from December 6th 2009. Aetna gladly deducted the amount of the social security disability award from the plaintiff’s check each month. Despite the findings of SSA, Aetna later disagreed with the SSA findings of total disability.

Conversion of Disability Definition from ‘Own Occupation’ to ‘Any Reasonable Occupation’

On February 25th 2010, the plaintiff’s case was referred by AETNA Life for a peer review by an occupational medicine specialist. The specialist hired by Aetna opined that the medical documentations provided by the plaintiff did not support a functional disability from any occupation. The review was forward to the plaintiff’s attending physician by AETNA Life for comment and requested an explanation or documentation if the attending physician did not agree with the opinion of the occupational medicine specialist. ATENA life also requested that the attending physician responded within 15 days which unfortunately the attending physician did not do so until April 22nd 2010.

An Occupational Analysis prepared by AETNA Life on April 8, 2010 concluded that the plaintiff would be able to engage in several different occupations based on her training and education and on the findings of its peer reviewer that she could work a sedentary job. Thus, AETNA informed the plaintiff on April 14th 2010 that it was terminating the plaintiff’s LTD benefits effectively from April 9th 2010. The ground for the termination of the plaintiff’s LTD benefits was that she was not disabled from any reasonable occupation due to the lack of response from her attending physician to the peer review and an absence of “objective medical evidence of restrictions precluding her from working a full-time sedentary job.”

The Appeal of AETNA Disability Claim Denial

The plaintiff in view of AETNA Life’s decision to terminate her LTD benefits submitted an appeal to the decision on January 10th 2011. Further medical documentations and clarifications were provided by the plaintiff to AETNA Life to support her appeal. In February 21st 2011, AETNA Life “partially overturned” its April 14th 2010 decision. It extended benefits to the plaintiff from April 9th 2010 to November 30th 2010. It refused to pay LTD benefits beyond November 30th 2010 because

the records presented for review do not provide any abnormal examination findings, imaging studies, or behavioral observations, dated after 11/30/10, to document any specific impairment that would prevent [her] from performing the work of any occupation.

According to AETNA Life, this decision was based on three physician reviews and peer-to-peer conversations conducted.

The Claim For Relief

As a result of ATENA Life refusal to consider its denial of LTD benefits to the plaintiff beyond November 30th 2010, the plaintiff was forced to file a lawsuit against AETNA Life for the wrongful denial of benefits under ERISA. In the lawsuit, the plaintiff alleged that AETNA Life failed to consider the medical opinion of her attending physicians and the determination of her disability status by the SSA and arbitrarily terminated her LTD benefits. As such, the plaintiff is seeking the following relief from the court:

  • Review the termination of benefits under a de novo standard of review
  • Declare that she is entitled to past LTD benefits from December 1, 2010 through the present
  • Reinstatement of her LTD benefits
  • An award of pre-judgment interest through the date of payment
  • Payment of attorney’s fees and costs associated with attempting to secure the benefits owed to her

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
(53)

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 53 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
(861)
Showing 12 of 861 Videos
Disability Benefit Tips
(329)
Showing 8 of 329 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 #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 >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves th... Read More >
Dell Disability Cases
(369)
Showing 8 of 369 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
(764)
Showing 8 of 764 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.