Question

How do I proceed about Aetna STD and their denial of my claim considering my current diagnosis?

Asked on August 11th 2011 by Marlene Long
I was placed on short term disability last year for about 3 months after a car accident and my STD insurance company Aetna paid me for the 3 months I was on leave. I returned back to work and began having issues again and changed doctors as my prior doctors did not know how to treat me. I was sent to a chiropracter who was treating me. He placed me on STD leave in Feb, 2011 for 2 weeks and 2 days thinking this would help my condition. Upon his evaluation after the leave, I was only allowed to return to work on a part time basis. He also sent me to a Neurologist who ended up diagnosing me with Fibromyalgia. The chiropracter advised that he believed that I had other issues with my back. Aetna paid me part-time until April 1, when I was placed on full-time disability leave. They denied my claim and upon appeal, sent my case to a Rheumatologist to evaulate. Please note Aetna is also my medical insurance company. These doctors did not make my primary care doctor aware of all of this as they told me they were. Upon advise of a friend, I spoke with both doctors about seeing a rheumatologist and they said it wouldn’t hurt. While waiting for appointment to see rheumatologist, Aetna denied my appeal. I have since seen my primary care doctor who advised that both doctors should have sent me to a rheumatologist once the Fibromyalgia was diagnosed. I have since seen the rheumatologist who confirmed that I do indeed have Fibromyalgia. He has ordered further testing and suspects that I might possibly have Spondloaropathy. I only have the MRI left to do. He has also diagnosed me with restless leg syndrome and per a sleep study results, I have sleep apnea. I have applied for Social Security Disability and am waiting for an answer. However in the meantime, I have no income coming in. How do I proceed about Aetna STD and their denial of my claim considering my current diagnosis?

Answer

Answered on August 11th 2011 by Attorney Gregory Dell

Marlene, If you have exhausted all of your ERISA appeals, then you have the option to file a lawsuit against Aetna at this time. In order to determine if we could assist you we would need to review your denial letter and a copy of your Aetna Disability Policy.