Aetna Ordered to Produce Internal Statements of Policies, Procedures and Guideline Relative to Claimant’s Long-Term Disability Claim

Prior to ceasing work due to her disability, Ms. S was employed as a service center organizer for Boston Building Service. Her duties included providing worker support during the grievance process with the union, and field support various union related issues. In December 2008, Ms. S was forced to stop working and file for disability insurance benefits due to chronic knee and back pain. Ms. S also suffered from hypertension, gastro esophageal reflux disease, hypothyroidism, obesity, depression and anxiety.

Aetna approved Ms. S’s claim for disability benefits through the entire 26 week short-term disability period, and paid long-term disability benefits through June 2011. During this time, Aetna even hired a third-party firm, Allsup, to represent Ms. S in her claim for social security disability benefits. By hiring Allsup to represent Ms. S in her social security disability claim, it increased the chances that Ms. S’s benefits would be approved, while also reducing the amount of disability benefits it would pay Ms. S, since the disability plans allowed Aetna to offset any social security disability benefits received from Ms. S’s monthly disability benefit.

Aetna Continues to Deny Disability Claim Through All Administrative Appeal Levels Despite Finding of Total Disability By Social Security Administration

Ms. S appealed the denial of long term disability benefits with Aetna. As part of her appeal Ms S submitted further evidence supporting that she remained disabled from her own occupation and any gainful occupation, as well as evidence that she met the Social Security Administration’s stringent standard of total disability; however, Aetna continued to uphold its decision to deny benefits.

Federal Court Orders Aetna to Produce Internal Statements of Policies, Procedures and Guidelines

Having exhausted all of the administrative appeals available under the long-term disability plan, Ms. S filed suit in the US District Court for Massachusetts. This claim was not handled by our law firm. Generally, ERISA lawsuits for denial of disability benefits are adjudicated on the administrative record compiled before the Plan Administrator. See Denmark v. Liberty Life Assur. Co., 566 F3d 1,10 (1st Cir. 2010). This means that the judge typically has to adjudicate the case solely on the administrative record created during the course of the insurance claim, and cannot consider any evidence not in the administrative record at the time the final decision to deny benefits is issued. This extremely limits the ability for the insured’s attorney to conduct discovery during the course of litigation.

However, Federal Courts typically allow some limited discovery into conflict of interest, as well as discovery of the administrator’s internal guidelines, plans and training manuals. Ms. S’s attorneys requested that Aetna produce internal statement of its policies, procedures and guidelines. Aetna objected to the request on the grounds that the documents were outside of the administrative record and not subject to discovery. After hearing arguments from both Ms. S and Aetna, the US District Court for Massachusetts ordered Aetna to produce its internal guidelines, policies, procedures, and training materials that were in effect at the time of claim denial.

If your claim has been denied by Aetna or you need assistance with any disability insurance claim, then contact any of our disability insurance attorneys for a free consultation.

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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.

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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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Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

Paul L. (New York)

Words can only scratch the surface regarding my experience working with Attorneys Dell & Schaefer. It’s a very emotional experience making the decision to utilize disability insurance. The unknowns were/are scary. From the very first phone call, the support staff was/are very professional and reassuring. I have been working with Attorney Steven Dell for approximately 10 years. He is confident, reassuring, listens to and addresses all my concern, and is extremely dilligent in understanding my specific policies for how they impact me. It is very reassuring that Steven handles and deals with the insurance company on my behalf. Attorney Dell’s team, and specifically Merlin, Attorney Dell’s assistant, is simply fantastic. Her professionalism and attention to detail have made all my communications with the office seamless.

Simply put, my experience with Dell & Schaefer made the emotional rollercoaster experience of my neck surgery seem like a walk in the park.

Thank You, Thank You, Thank You, to both Attorney Steven Dell and to Merlin for how you have helped me over these past 10 years.

Dilligence, Reassurance, Professionalism at every step, Confidence, Results.

With 10 years experience with working with Dell & Schaefer, taking that step to call Attorneys Dell & Schaefer was one of the best professional and personal decisions I have ever made.

You want to know what you can do – the below comment about posting your first name and last name initial on our website. Put up my full name, phone number, and email address. I will gladly speak to anyone about your office and tell them my story and how instrumental Steven and Merlin have been in my life over the past 10 years.

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