• Aetna Denial Of Disability Benefits For Boeing Employee With MS Reversed By Washington Federal Court

Court Finds Aetna Had No Credible Argument Whatsoever To Support Its Decision To Deny Benefits To Claimant With MS

When it comes to ERISA governed claims, no circuit is more plaintiff friendly than the 9th Circuit. A recent ruling by a Washington district court reminds us of that although the behavior by the disability insurer, Aetna Life Insurance Co., in Gorena v. Aetna deserved a strong reprimand.

Ms. Gorena worked as a staff analysist for Boeing for more than 10 years before leaving work due to her worsening multiple sclerosis. She had been diagnosed 8 years before seeking disability benefits and her treating neurologist was a well-known MS researcher.

In denying Ms. Gorena’s claim, Aetna relied on its reviewing medical consultant who found no evidence of functional capacity. The court overturned this determination and in the process expressed deep concern about Aetna’s treatment of the case.

The evidence in support of Ms. Gorena’s disability claim was comprised of years of records including 10 MRIs, 14 psychological reports, and 16 attending physician statements all confirming her inability to work. Despite the overwhelming evidence, Aetna’s medical consultant cherry-picked every phrase or detail from the materials that was indicative of some aspect of Ms. Gorena’s condition that was “stable” or “normal.”

The court pointed out that Aetna had totally disregarded a functional assessment completed by the treating neurologist that found, unequivocally, that Ms. Gorena could not stand or sit for sufficient time in an 8 hour work day as a result of her fatigue and cognitive limitations. The court was also disturbed by Aetna’s refusal to consider Ms. Gorena’s subjective complaints without giving any basis for questioning those reports.

In the end, the court found the objective weight of the treating doctor’s records and reports was greater than the evidence relied upon by Aetna. In reaching this decision it cited several factors including the treating doctor’s credibility and reliability in addition to his credentials which included a 20-year history of MS-related research and teaching.

The court overturned Aetna’s decision but took it even further pursuant to a provision of 29 U.S.C. § 1132(a)(1)(B), which allows a plan participant to sue to “clarify [its] rights to future benefits under the terms of the plan.” The court determined that Ms. Gorena had proved her disability under the own occupation as well as any occupation standards in her policy and that benefits were to continue “unless Aetna can establish that [Ms. Gorena] is capable of performing such work productively, full-time, and without undue disruptions and/or absences due to her MS and its related symptoms, she is to continue to receive LTD benefits to the Plan’s maximum duration.”

There is no question the court was offended by Aetna’s conduct in this case. Most courts would not have addressed future benefits but Aetna’s conduct was so egregious that the court felt the need to do so.

This case was not handled by our office, but we think it can be beneficial to those struggling to obtain long-term disability benefits. If you have any questions about your own disability claim, contact one of our attorneys at Dell & Schaefer for a free case evaluation.

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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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Jack B.

I called Dell & Schaefer the day I received the LTD denial letter, and immediately spoke with attorney Cesar Gavidia. From our phone conversation he understood what I was up against. After my denial I was feeling hopeless and was ready to throw in the towel. Cesar explained to me the next step was to file a lawsuit and take the case before a federal judge. We settled the case at mediation with the insurance co. rep and their counsel.

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