Question

Why can a doctor that I've only seen once decide I'm okay to work? What should I do if Aetna denies me again?

Asked on January 14th 2014 by Thomas W
I have paid into Aetna LTD for over 12 years. Well in 2012 I was diagnosed with diabetic neuropathy in my feet. I was placed on STD and then in Oct of 2012 I was placed on LTD for 12 months. In October of this year my LDT was revoked because a new doctor said in a phone interview that I might be able to work. I had only seen this doctor once for an initial consultation. Now I am appealing the decision and was told they where going to use his medical records and not my previous doctor. I have been waiting for there decision for over two months. During that time I have used up my savings accout to pay bills. What recourse do I have if they decline me again? I just do not understand why they will not take my previous doctor’s records.

Answer

Answered on January 15th 2014 by Attorney Alex Palamara

Thomas, Aetna typically only offers one level of appellate review. If your claim is denied again your only recourse would be to bring a civil lawsuit under ERISA. Despite their contentions, it is important that you provide Aetna with ALL of your medical records.