Aetna Life Insurance Company overturned previous denial of long term disability benefits for Georgia Assistant

Our client, Ms. A, formerly worked as an executive assistant for a town administrator. In April 2014 a number of co-morbid physical conditions and ailments forced Ms. A to stop working and submit her claim for disability benefits under her employer’s Long-Term Disability (“LTD”) Policy which was administered and funded by Aetna. Under the employer’s disability policy Ms. A would be considered totally disabled after the first 24 months of her disability if she was unable to work at any reasonable occupation solely because of an illness or injury. A “reasonable occupation” was considered any gainful activity for which she was, or may reasonably become, fitted by education, training, or experience, and which results in, or can be expected to result in, an income of more than 60% of her adjusted pre-disability earnings.

After paying Ms. A for 24 months under the LTD Policy, Aetna denied her further LTD benefits on the basis that she allegedly did not meet the policy definition of disability. Specifically, Aetna determined that she was “not totally disabled from performing any reasonable occupation for which you are qualified for by education, training or experience” and identified several occupations she allegedly could perform. After receiving the denial, Ms. A contacted Dell & Schaefer and discussed her case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in Aetna’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. A’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of Aetna’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of Aetna’s denial. The appeal next addressed Aetna’s inadequate medical and vocational reviews. Specifically, Aetna’s reliance an in-house Transferable Skills Analysis (TSA) was unreasonable because (a) Aetna misstated and mischaracterized Ms. A’s treating physician’s Capabilities and Limitations Worksheet (CLW) and ignored Ms. A’s most recent and relevant medical information; and (b) the TSA relies on these faulty restrictions and limitations to determine Ms. A had sedentary capability. What’s more, the electronic claim notes confirmed that Aetna’s in-house nurse reviewer concluded that Ms. A was “significantly limited in most function” and she was “on pain medications that may cause side effects” and that “her ability to perform activities beyond ADLs [i.e., activities of daily living] is questionable.” In sum, the restrictions and limitations assigned to Ms. A by her treatment provider did not, as Aetna suggested, support her ability to perform at a sedentary work level, which was confirmed and supported by Aetna’s own in-house nurse reviewer.

Several months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, the parties agreed to a negotiated financial resolution of Ms. A’s claim. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.

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FAQ

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.

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Russel H. (Texas)

My experience is as such. I suffer from a variety of mental health issues the biggest being severe PTSD. When I had lost all hope the Good Lord guided me to Attorneys Dell & Schaefer. My assigned lawyer, Stephen Jessup, was the most understanding and compassionate human being I had come across since my breakdown. He not only guided me legally, but his kind words and understanding helped me spiritually as well. His co-worker, Sonia, was a heaven-send as well. Her kind words and prompt responses were amazing. Both Stephen and Sonia will never understand how blessed I am that they came in to my life at my darkest hour. Their work ethic and rigorous efforts towards my case gave me not only a win but it gave me justice and at the end of the day that’s all I wanted. I went in to this case with legal counsel and I left this with great friends. I was always informed, spoken to with the utmost respect and sincere compassion.

Stephen and Sonia, y’all are my silver lining in humanity. I’m a better person today having met you both even if only by phone and email.

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