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Aetna refuses video recording of IME and threatens to deny disability benefits unless claimant agrees to sign IME doctor’s authorization form

In my opinion Aetna’s handling of our client’s long term disability claim is egregious and unreasonable. We share this story with you in order to continuously educate the public about the conduct of many disability insurance companies.

My client suffers from fibromyalgia, depression, and multiple other conditions. She has been receiving benefits from Aetna for two years and her definition of disability recently changed from own occupation to any occupation. Aetna has requested an “Independent Medical Exam” in order to have her examined by a doctor of Aetna’s choice. While Aetna refers to the exam as an Independent Medical Exam (“IME”) the correct name is a Compulsory Medical Exam (“CME”) as the policy requires our client to appear at the exam. Our client has agreed to go to the CME, yet she requested to have the examination either videotaped, tape recorded, or have an independent witness appear with her. Aetna denied the request for video or an audio recording device and stated in writing, “To ensure an independent evaluation no video or recording devices and no presence of person other than the examinee.”

We sent Aetna a letter in response and stated:

“You have stated the following in your letter which does not appear anywhere in the long term disability plan language:

To ensure an independent evaluation, the following conditions must be observed:

  • No video or audio recording devices.
  • No presence of persons other than the examinee. No children. No attorneys. An exception will be made for an independent interpreter in cases where there is a known langage barrier.

With all due respect it simply does not make sense to state that prohibiting a video or audio device will “ensure an independent evaluation”. There is nothing more accurate than a videotape recording of every single thing that takes place during the examination that AETNA is requiring. In order to verify accuracy all lottery drawings are videotaped, United States congressional sessions, and most law enforcement interrogations. Certainly videotaping has been proven as a method of accuracy. The act of refusing to allow the videotaping of a CME exam requested by an insurance company is unreasonable and unfair to all plan participants. If you are concerned somehow about the accuracy of the video recording, we have no problem if Aetna hires the videoagrapher that will attend the examination. We have no problem with AETNA, the examining doctor and the claimant all receiving a copy of the videotape. Furthermore, if AETNA believes the cost of the video is a problem, then our client will pay for it. AETNA has a fiduciary duty to act in the best interest of its plan participants and a video tape of the exam is the number one method to maintain independence and validity in a CME.”

Aetna’s responded by stating they are not allowing the exam to be video recorded and if your client does not go to the IME exam with Dr. Stephen Demeter then we will deny her benefits. We further advised Aetna of Dr. Detemer’s reputation for conducting more than a thousand IME exams for disability insurance companies and his affiliation with the Reed Group as a member if it’s medical advisory board. The Reed Group advertises themselves as “The World’s Most Trusted Return to Work Experts.”. In my opinion this means, hire the Reed Group and we will find a doctor that will usually say that the claimant is not disabled.

In anticipation of the CME exam with Dr. Demeter we contacted the office of Dr. Demeter and asked if they had any forms they wanted our client to fill out before she arrives. We reviewed the multiple pages Dr. Demeter requested, and one of them was a document titled Individual Patient’s Authorization. We reviewed Authorization with our client and we found it be poorly drafted and almost impossible to understand. Our client had already signed numerous authorizations allowing Dr. Demeter and Aetna to review all of her medical and occupational records. It is highly unusual for an IME doctor to have a disability claimant sign a generic authorization form. Stephen Scott, the Aetna Claims Analyst called our office today and said that our client must sign the form or Dr. Demeter won’t exam her. He then said that if Dr. Demeter does not exam her, then her benefits will be denied. I asked Mr. Scott to explain the form to me and he was unable to do so. I asked Mr. Scott to take the form into his supervisor’s office and have him explain it to me, but Mr. Scott stated that he was at home and he could not meet with the supervisor. I hung up with Mr. Scott and sent him the email listed below.

From: Gregory Dell
Sent: Wednesday, December 15, 2010 5:12 PM
To:scotts4@aetna.com‘; ‘frontdesk@hsmed.com
Cc: Anneli DeCardenas
Subject: IME WITH DR. DEMETER at Honolulu Sports Medical inc.

Scott:
Thank you for calling me about the document titled INDIVIDUAL PATIENT’s AUTHORIZATION that Dr. Demeter’s office is requiring Ms. Rose to sign. I have advised you that my client and I do not understand the form and have asked for clarification. I have asked you to explain the form to me and you were not able to. You advised me that if Ms. Rose does not sign the form then the doctor will not examine her and you will stop her benefits. How could my client possible pay any of her bills if you decide to cut her benefits for failure to sign a form that cannot be understood. You have once again left my client with no options as she cannot afford to have her long term disability benefits stopped by Aetna. As such she will have to sign a release form which make absolutely no sense and appears to not be HIPPA compliant. I have asked you to contact your supervisor and see if he understands it. Unfortunately this disability claim is governed by ERISA and I cannot immediately go to the court to prevent you from denying disability benefits. As such, AETNA continues to hold the gun to my client’s head and she will have to sign a document which neither myself or her understand. You should not forget that AETNA has already prohibited our client from videotaping the exam, recording the exam, or bringing an independent witness to attend the exam. I have advised you that my client has no objection to Dr. Demeter reviewing all of her records, but it is outrageous for her to be required to sign an authorization form that no reasonable person would understand. I have already advised you that Dr. Demeter and Honolulu Sports Medical Inc. have performed thousands of IME exam, so I am surprised that they would be requiring people to sign a generic release form that cannot be understood. Certainly Dr. Demeter could use some of the proceeds from his thousands of IME exams to draft an authorization form that is written in plain English. My client will be at the Compulsory Medical Exam and she will sign the form under duress as Aetna has given her no other option. We look forward to receiving a copy of the report upon completion.

Gregory Michael Dell, Esq.
Attorneys Dell & Schaefer Chartered
Nationwide: 888-SAY-DELL(729-3355)

The Aetna Supervisor called me about 30 minutes later and basically said the form needs to be signed so that Dr. Demeter can send the report he completes to Aetna. I advised Aetna that the form clearly did not state what he thought it said. The Aetna supervisor said there is nothing we can do and she must go to the exam. I advised the supervisor that my client will be at the exam and she will sign the form as Aetna has threatened to stop paying her benefits if she does not sign it. The supervisor and the claims examiner basically had the same attitude, which was we don’t care and we will talk to you after we get the report back from our hired gun doctor.

The outcome of this scenario will hopefully be that Dr. Demeter determines our client has restrictions and limitations, which will require Aetna to continue to pay her disability benefits. I am skeptical about the outcome of Dr. Demeter’s opinion as the last IME exam at Honolulu Sports Medical Inc., was with Dr. Peter Diamond. Dr. Peter Diamond and Dr. Stephen Demeter work at the same office. In a previous disability claim, Dr. Peter Diamond was hired by Prudential Insurance Company to conduct an IME exam and he found that our client was not disabled. A Hawaii federal judge subsequently disagreed with Dr. Diamond’s findings and reversed Prudential’s denial of disability benefits.

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FAQ

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.

Dell & Schaefer Client Reviews   *****

Celestine D.

I am a 61 year old Senior Business Analyst. I had been working at a health insurance company for approximately 11 years when I became disabled and have had numerous, bulging disks, nerves that were severely impinged, and active arthritis and degenerative disk disease throughout my spine. I underwent back surgery for L1 thru L5 infusion which included insertion of 2 titanium rods and 6 pins. I continue to undergo physical therapy 3 xs per week. Not to mention the surgery left me worse than before the surgery considered a FAILED BACK SURGERY. I’m unable to sit or stand for more than 2 hours with getting up. I am unable to walk for more than 1 city block. I also have many other medical conditions. After collecting LTD from Lincoln Financial for about 3 years, the harassment began. They decided that I was no longer disabled. In short they felt I was capable of returning back to the work force. (Social Security Disability deemed me permanently disabled)

After fighting with Lincoln and exhausting my appeals I decided to research and hire an attorney. I selected Dell & Schaefer based on their website, case success statistics, and the speed at which they returned my calls and emails.

Let me tell you, my experience in working with Rachel Alters and her assistant Michal Mizrahi is nothing short of outstanding. They responded quickly to phone calls and emails and were mindful of my concerns and information needs. Talking with the both of them made me feel confident and assured they were doing the best for me. I cannot say enough good things about Michal. She anticipated my needs and was proactive in keeping me informed as my case progressed. What a TEAM they make. Any time I reached out with questions or concerns they were very responsive and always left me feeling satisfied that I had the best in my corner. Rachel is an angel. She is so down to earth compassionate, professional and trustworthy attorney. Rachel was there to guide me from the start and helped me get through this stressful and lengthy process.

While attempting to handle it on my own, my long-term-disability claim had been denied two previous times. With the help of Rachel Alters and her team, I was able to obtain a settlement I never would have been able to get without their assistance. Rachel and her team far exceeded my expectations in every capacity. She was focused, clear, responsive, efficient and above all exceedingly knowledgeable.

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