Aetna Overturns Denial of Long Term Disability Benefits to Bank Manager with Multiple Sclerosis Following ERISA Appeal

Our client was a former credit manager for a large banking institution who was suffering with Multiple Sclerosis. Despite his best efforts to continue to work through his continually worsening symptoms, he finally succumbed to the multiple effects of MS and filed for short term and long term disability benefits with Aetna. Aetna initially approved his claim for short term disability benefits based upon the medical records forwarded from his doctors. However, when his claim was to convert to long term disability, Aetna determined that the records that had supported his claim for short term disability benefits somehow no longer supported his claim for long term disability benefits.

Why Would Aetna Deny Benefits For Long Term Disability Benefits Based On Medical Records It Had Used To Approve Short Term Disability Benefits?

Like many employer provided disability policies, the short term disability policy is often funded by the employer, which means it is the insured’s former company that is responsible for penning the check. However, more often than not when the claim becomes one for long term disability benefits the funds that pay the benefit comes out of the assets of the insurance company. Essentially, when an insurance company is footing the bill, it is not surprising when they no longer feel that the medical records that supported short term disability no longer support long term disability.

Diagnosis Does Not Equal Disability According to Aetna

Aetna denied our client’s long term disability claim based on what it considered to be a lack of objective medical evidence to support physical restrictions and limitations that would result in the inability to work. Essentially, Aetna was claiming that although our client had Multiple Sclerosis, there was not enough documentation to support that he was prevented from performing the duties of his job. This is a very comment argument that insurance companies use when evaluating claims for mental health or pain conditions that is now being seen with somewhat more frequency as it relates to Multiple Sclerosis. It is the duty of the claimant to provide the requisite information to draw the nexus between diagnosis and disability.

The ERISA Appeal For Long Term Disability Benefits Against Aetna

Following his denial of long term disability benefits, our client contacted Dell & Schaefer to assist him in the filing of his administrative appeal. Attorney Stephen Jessup was assigned to his case and quickly set out to develop a plan of attack to provide adequate documentation to counter each of Aetna’s reasons for denying the claim. Understanding the strategy employed by Aetna, Attorney Jessup coordinated testing to document the physical and cognitive limitations that were preventing our client from working; reviewed all of our client’s medical records; and contacted our client’s treatment providers to complete specifically crafted questionnaires that addressed Aetna’s position that our client was not prevented from working in his occupation. Attorney Jessup then correlated the findings of the preceding to unequivocally prove that our client could not work in his former capacity. Following the submission of the appeal, Aetna overturned its denial of benefits, reinstated our client’s claim and forwarded all back benefit checks.

Proving Disability Is Not An Easy Burden

Under ERISA based disability policies, it is the responsibility of the insured to prove disability. A diagnosis of a medical condition is not sufficient to satisfy the terms and conditions of most disability policies. The nexus between the condition and how it affects one’s ability to work must be sufficiently established if one hopes to have their claim approved. If your claim has been denied and you need assistance in filing your ERISA appeal or lawsuit, then please contact Attorneys Dell & Schaefer for a free consultation.

Read more about Multiple Sclerosis disability claims.

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, 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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Jeff G., DDS

My single best decision regarding my disability claim was to retain Dell & Schaefer from the beginning. From initial claim submission to claim maintenance they have been my teammates throughout the entire process. This is their area of expertise, and in my opinion, they are great at it. They are extremely professional. They are on top of every aspect of my claim. They respond to all of my questions in a timely manner and they handle all correspondence with the insurance company. I have found that filing a disability claim is not a smooth process and having the professionals at Dell & Schaefer on my team has been priceless. I have referred friends and colleagues to this law firm and without exception, we all are happy with our representation. Without equivocation, if you are going to file a disability claim, you want Dell & Schaefer on your team.

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