Aetna Overturns Denial of LTD for Former Employee of The Home Depot

Prior to enlisting our services to challenge a denial, our client had received benefits from Aetna due to his disabling conditions for 18 months. Unfortunately for our client, Aetna decided to deny benefits due to the “change in definition of disability.”

Common in most group disability insurance policies, the change in definition typically happens after benefits have been paid for 18 or 24 months. For the initial 18 months, in order to be considered disabled, this former Sales Associate had to merely prove that he could not perform the material duties of his own occupation. After the 18 month mark, the former Home Depot employee then had to prove that he was unable to work at any reasonable occupation. A reasonable occupation is one which a claimant is fitted for by their education, training or experience and one which would pay 60% or more of the claimant’s pre disability earnings.

Unfortunately for our client, on the exact day that the change in definition of disability occurred, Aetna made the determination that he did not satisfy the new definition of disability and Aetna denied benefits. Although our client suffered from a host of disabling conditions which included migraines, fatigue, lumbar radicular pain, sciatica, leg ulcers, osteoarthritis, cervical issues, diabetes, kidney disease, fibromyalgia, etc., Aetna remarkably believed he no longer satisfied the new definition of disability.

In support of its decision to deny benefits, Aetna relied up on the report of a Peer Reviewer who never met with or evaluated the claimant but who concluded that he would be “capable of working a full time sedentary job.” This reviewer also concluded that he was “not functionally impaired based on the medication documentation.”

Review of the Record:

After speaking with the claimant, Attorney Alexander Palamara agreed to take on this claim and assist the claimant with an appeal to challenge the denial. The first thing Attorney Palamara realized is that Aetna’s conclusion that the claimant was “not functionally impaired” was laughable. A quick review of the recent medical documentation showed clear objective evidence that our now client suffered from various medical conditions that left him with severe restrictions and limitations. Objective evidence included multiple MRI’s of the brain that revealed white matter changes, very high blood pressure readings, multiple falls due to impaired balance, impaired sensation, ulcers, positive x-rays of the knees, and decreased range of motion.

Appeal by Attorney Palamara:

An appeal was filed by Attorney Alexander Palamara. The appeal initially cited many issues with Aetna’s reviewing doctor’s report and the fact that it overlooked objective evidence which supported the claim. Beyond fighting the review, the appeal also focused on the evidence in the file and the great support from each of the treating providers who each essentially stated that the claim was “not able to work.”

The appeal also noted that in 2017 alone our client had “been seen 11 times by his doctor, spoken to his physician 12 times, corresponded via email 8 times, been seen in the Emergency Room 5 times, had 1 inpatient hospitalization, 3 urgent care appointments, 3 visits to the GI clinic, 1 visit in neurology, 4 visits in urology, 5 times seen by his psychiatrist and also been seen by several medical professionals in Columbus, Ohio.”

The appeal concluded that Aetna’s decision had to be overturned due to the overwhelming evidence which supported no other conclusion but to find our client disabled under the new definition of disability.

Claim Re- Approval:

On December 20, 2018, we received word that Aetna had decided to overturn its decision to deny benefits for the period of March 15, 2018 through October 25, 2018. Aetna had agreed to pay benefits for that time period as it continued its review for benefits beyond October of 2018. However, at the same time we received word that the claim had been reapproved for that short period of time, we submitted updated records and a Notice of Award from the Social Security Administration which showed that Social Security had now concluded that our client was also disabled. On December 31, 2018, Aetna informed us that it had determined that our client now meet the definition of being totally disabled from any occupation and agreed to reinstate continued benefits.

Our client is happy to get his re-approval and knows that we will continue to fight to get him all the additional benefits he is owed. He knows that Dell & Schaefer will always do whatever it takes to get him his deserved benefits. If you have been denied disability benefits by Aetna or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.

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.

Dell & Schaefer Client Reviews   *****

BK. K.

After my claim was denied I was at a standstill. Not knowing what to do next, I happened upon Dell & Schaefer on an Internet search… skeptically I investigated and did due diligence. After initial contact, I firmly realized it was in my best interest to have Dell & Schaefer represent me. Throughout the appeal process, my emails were answered, my phone calls were returned and there was no such thing as a stupid question. It was a complicated case and my confidence was positive throughout the appeal experience. After several months I was put back on claim and there is no question I could not have done this without Dell & Schaefer’s excellent and fair representation.

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