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AETNA Life Insurance Company sued for failure to pay out disability benefits to ex senior nurse suffering from disabling mental conditions

On March 29th 2011, a lawsuit was filed against the AETNA Life Insurance Company (AETNA Life) at the District court for the Southern District of Florida. In the lawsuit, the plaintiff alleged that AETNA Life had refused to pay the disability benefits sought by the plaintiff under a group long term disability (LTD) benefits policy that was issued and administered by AETNA Life.

The Nature of the Complaint

The plaintiff was a Senior Emergency Room Registered Nurse employed by the University of Miami Hospital. As a result of his employment at the University of Miami Hospital, the plaintiff was a participant of a group insurance policy for LTD benefits that was issued and administered by AETNA Life. As a participant of the policy, the plaintiff was entitled to disability benefits in the event of him becoming disabled. Under the policy, “Disabled” was defined as:

From the day that you first become disabled and until Monthly Benefits are payable for 60 months, you will be deemed to be disabled on any day if:

  • You are not able to perform the material duties of your own occupation (full time or part time) solely because of disease or injury and
  • Your work earnings are 80% or less of your adjusted pre-disability earnings

After 60 months that any Monthly Benefits is payable during a period of disability, you will be deemed disabled on any day if you are not able to work at any reasonable occupation solely because of disease or injury.

The plaintiff as a result of suffering from several disabling conditions like obsessive compulsive disorder, bipolar disorder and psychotic hallucinations was prevented from performing the material duties as required under his occupation and any other reasonable occupation. Due to his inability to work, the plaintiff ceased working on November 24th 2008 and filed an AETNA disability claim.

As required under the policy, the plaintiff informed AETNA Life of his disabling conditions. Medical documentations relating to the plaintiff’s treatment was provided to AETNA Life to support the claim of being disabled. In addition, the plaintiff’s job description with the University of Miami Hospital was provided to AETNA Life. At the same time, the plaintiff’s attending physicians also consistently informed AETNA Life that the plaintiff is disabled as with the same conclusion drawn up by Social Security Administration. The Social Security Administration recognizing that the plaintiff was disabled, provided him with monthly Social Security Disability Income payments but made to a trusted individual due to the plaintiff’s mental health problems.

Despite the legitimacy of the plaintiff’s claim for disability benefits, AETNA Life on July 27th 2009 by way of correspondence denied the claim for disability benefits. According to AETNA Life, the “medical information received and reviewed failed to support functional impairments that would preclude [the plaintiff] from performing the essential job tasks of [his] occupation as a Senior Emergency Room Registered Nurse”.

Relief sought by the plaintiff under the lawsuit

Despite requesting a review of AETNA Life’s decision on January 25th 2010 and providing additional medical documentations from the plaintiff’s attending physicians and licensed therapists supporting the review, AETNA Life again denied the plaintiff’s claim for disability benefits on July 27th 2010. Exhausting all his administrative remedies with AETNA Life under the Employee Retirement Income Security Act (ERISA), the plaintiff has no recourse but to file a lawsuit against AETNA Life seeking:

  1. All the benefits that he is entitled to under the plan including of prejudgment interest retroactive to the day that the benefits were terminated;
  2. Reasonable attorney fees and costs as a result of pursuing this action against AETNA Life;
  3. Appropriate equitable relief which the court deem just and proper due to the act and omissions of AETNA Life.

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We represent Aetna clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Aetna disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Aetna. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Aetna.

How do you help Aetna claimants?

Our lawyers help individuals that have either purchased a Aetna long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Aetna:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
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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.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com 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.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer 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.

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Les D. (Montana)

I reached out to Dell & Schaefer because my ongoing disability claim was being closed, my 3 appeals were unsuccessful. Steve was extremely professional and empathetic to my situation. He did a lot of work & won the appeal with CIGNA, got the checks coming including all past payments. The care and prompt handling of my claim didn’t stop there. Steve and his assistant Sonia were always ready to answer questions & concerns promptly and professionally. They genuinely cared and were interested in how I was doing.

After a year Steve negotiated a buyout settlement on my claim. I couldn’t be happier with his handling of the entire process. Steve and Sonia have truly made my life easier, I know I couldn’t have won my case alone. I can genuinely say I will miss them, their caring & kind words of reassurance. They always put my best interests first and foremost. I give them & the firm my highest recommendation. I would not hesitate to tell anyone who needs an attorney to use them.

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