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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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Questions About Hiring Us

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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My experience has been very good; but for his representation the insurance company would not have agreed to pay my disability benefits.

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