Social Security Approval Does Not Mean Disability Insurance Benefits Must be Approved
A common question we receive from claimants is how one can be approved for social security disability benefits but denied private disability insurance benefits. A recent case decided by the 11th Circuit Court of Appeals touched on this issue and reminds us that different disability programs have different standards of determining disability and it is possible to be approved under one standard of disability and denied under another.
In this case, the 11 circuit court of appeals upheld a lower court’s finding that Aetna’s decision to uphold a denial of benefits to a claimant was not wrong.
Mr. Oliver, a FedEx Courier had obtained disability insurance coverage from his employer and following a work injury he received own occupation disability benefits for 24 months. Shortly before the 24 month mark Aetna notified Mr. Oliver that to qualify beyond 24 months he would need to show that he had a complete inability to engage in any compensable employment for 25 hours per week.
Mr. Oliver applied for total disability and was denied. His appeal was also denied with Aetna finding that there was a lack of significant objective findings to substantial his claim for total disability.
Around the time of the denial, Mr. Oliver was notified by the SSA that his SSDI claim was approved. Aetna was notified of the favorable SSA finding but stated in the appeal denial that the SSA determination did not dictate the outcome of Aetna’s review.
Mr. Oliver filed a lawsuit and a federal district court found that Aetna was not wrong.
In reviewing the decision the circuit court upheld the district court’s decision and found that a claimant could not simply rely on the SSA determination to show the administrator’s decision was wrong where the plan’s test for disability differed in several ways and where the plan required significant objective findings.
This case is a good reminder that a finding of disability from the SSA does not mean your disability carrier must also approve your benefits. While the disability carrier is required to consider the SSA finding during its review the SSA standard is different from the standard in most disability insurance policies.
In sum, whether Plan Administrators are required to have your claim reviewed by an independent vocational expert ultimately depends on the language in your particular insurance policy.
Resources to Help You Win Disability Benefits
Get Your Disability Application Approved
Prevent a Disability Benefit Denial
Negotiate a Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Q: Can Aetna deny my application on the basis of pre-exisiting condition? Do they discriminate against the mentally ill?
Q: Are there any circumstances in which I can appeal LTD after the number of days Aetna gives you to appeal?
Q: What can I do to stop Aetna from harassing me and realize that not all disabilities are the same?
Dell Disability Lawyers file Lawsuit in Federal Court against Aetna after it denied long-term disability benefits to former software Developer
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
Court Rules That Aetna’s Failure To Consider Plaintiff’s Actual Job Duties Was Arbitrary And Capricious
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.