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Aetna Life Insurance Company Ordered by Federal Court Reconsider the Claim of Amazon Employee Disabled Due to Urinary Incontinence

In July 2016, Kimberly Garner, suffering from urinary incontinence, left her job with Amazon, and filed a claim for long-term disability benefits with Amazon’s long-term disability insurer, Aetna Life Insurance Company.

The Amazon Long-term Disability Plan required that in order to receive monthly benefits, the employee insured must be unable to “perform the material duties of [their] own occupation solely because of an illness, injury or disabling pregnancy-related condition; and [their] work earnings are 80% or less of [their] adjusted pre-disability earnings.”

Ms. Garner had suffered with the complications of her condition since at least 2009. She had seen a urogynecologist, undergone several surgeries, and even undergone botox treatment – usually reserved for women for whom other treatments had failed. Her treating physician noted that testing showed a “diminished bladder capacity” and that she continued to experience urge incontinence and stress incontinence. Despite the overwhelming evidence in support of her disability claim, Aetna denied her disability claim, as well as her subsequent appeals.

As for its basis for denying Ms. Garner’s disability claim, Aetna justified its decision based on the reviews and opinions of a physician and nurse consultant it had engaged to perform a medical review of Ms. Garner’s claim.

After having exhausted her administrative appeals with Aetna, Ms. Garner filed suit in Federal Court alleging that Aetna had violated ERISA when it had denied her disability claim. Ms. Garner sought recovery of the disability benefits that Aetna had failed to pay and reinstatement of her claim. Ms. Garner argued and the Court found that Aetna had not considered all of the medical evidence and that the opinions of Ms. Garner certifying doctor were disregarded and rejected in favor of the opinions of the physician and nurse Aetna had consulted. The evidence showed that Ms. Garner’s condition had not improved and that her symptoms had been reported by her treating physicians as being severe and persistent.

However, despite finding that Aetna’s decision was unreasonable “based on primarily insufficient reasoning”, and concluding that Aetna’s denial of benefits was indeed arbitrary and capricious, the Court, instead of awarding Ms. Garner the benefits she was rightly owed and deserved, remanded the case to Aetna for further review. The Court did however leave the door open for Ms. Garner to file a petition for attorney fees based on the her success on the merits of her disability claim. It is within the Court’s discretion in ERISA disability cases to award or deny attorney fees to a prevailing party.

Although this case was not handled by our firm, it is an important Court decision for any claimant needing assistance with a disability insurance denial. If you have been denied disability benefits by Aetna or any other disability insurance company, please do not hesitate to contact Dell & Schafer for a free consultation.

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Do you help Aetna claimants nationwide?

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
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

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 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.

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 800-682-8331 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.

Dell & Schaefer Client Reviews   *****

Jim C.

It has been almost 7 years since I became unable to work. I looked at the possibility of filing my disability appeal myself after Hartford Insurance Company denied my claim, but it soon became clear that I would have no chance of winning. So I started looking for an attorney. I talked to several who told me just how much work they would expect me to do on the claim. I then revisited the idea of filing by myself. Then I talked to Greg Dell. He told me not to worry about anything, that he and his firm would handle everything. The insurance company threw up every roadblock they could but we eventually prevailed and my benefits were reinstated. They have immediately jumped on any issues since then and resolved them quickly.

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