Aetna Reinstates Benefits for Former SAP America Employee Suffering the Effects of a Head Injury

My now client worked for SAP America, Inc. as a Senior Solutions Sales Executive for nearly seven years. She made a great salary working at a job and employer she loved. Her work required superior cognitive and analytical skills and was both challenging and rewarding. Unfortunately for her, in December of 2016, she suffered a serious head injury. While she attempted to remain working, as of January 2017 her symptoms of headaches, dizziness, memory lapses and nausea proved too much. This was after all, her 5th concussion dating back to her childhood. Fortunately for her, her employer provided its employees with coverage under a Long Term Disability Insurance policy and this policy was thankfully with Aetna Life Insurance Company.

Claim Initially Approved and Then Denied

After our client applied for benefits under the LTD policy, Aetna initially approved the claim and benefits effectively began in July of 2017. Aetna had thus concluded that she was unable to perform the material duties of her own occupation. However, Aetna was not approving her claim due to her brain injuries; Aetna was merely approving her claim as it believed that she may be impacted psychologically. Giving credit to Aetna, although they stated they found no support for cognitive impairment, they approved her claim as they wanted to allow her time to get in appropriate treatment for any psychological condition she may have been suffering from. This is unique and Aetna should be commended for the actions it took initially with this claim.

While its overlooked documentation regarding the claimant’s brain jury, it acted in good faith and paid benefits while allowing the claimant time to gather additional support for her claim.
Unfortunately for our client, her approved status changed in March 2018 when Aetna then determined that she did not meet the definition of disability. Aetna pointed to the fact medical documentation in support of any psychological impairment was not provided and that it concluded that a review of other medical documentation was insufficient to show any functional impairment. Aetna believed that “physical exams and diagnostic findings” were “unremarkable” and there was “a lack of supporting documentation to provide functional limitations from a physical or mental health perspective that would prevent (her) from performing (her) own occupation…”.

Client Finds Attorney Alexander Palamara of Dell & Schaefer

Knowing Aetna’s decision to be wrong, the claimant found our firm and contacted us immediately after receiving the denial letter. After speaking with the claimant and reviewing the denial letter, it was easy to see that Aetna’s denial was incorrect. The claim file was immediately ordered from Aetna. Additionally, all medical records pertinent to this claim were ordered from each of our client’s treating providers. Such documentation included the report of a Neuropsychological Evaluation conducted in September 2017 as well as reports from physical examinations and other diagnostic testing. In addition to a gathering of all supportive medical records, Attorney Palamara arranged for an independent review of our client’s medical records by a board certified internal medicine and primary care sports medicine physician who specializes in the treatment of Traumatic Brain Injuries.

An appeal was timely filed. The appeal pointed to the supportive medical documentation, outlining everything Aetna seemingly overlooked. The appeal also pointed to the history of support from the treating providers. The appeal then pointed to the extensive and intricate requirements of our client’s occupation. Lastly, our appeal relied upon the findings of the independent reviewing doctor who stated in his report that he “unequivocally opined that (our client) is disabled from her previous job” and pointed to all medical records that supported his conclusion.

Thankfully, our appeal was successful and Aetna overturned its previous denial. Our client is now back on claim and receiving her full monthly benefit. Although she went without benefits, she is thankful to be back on claim. She also is confident that she will remain on claim for as long as she needs to as she knows Attorney Palamara will continue to do whatever it takes to keep her on claim.

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.

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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

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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.

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.

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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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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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Sean D. (New York)

During a very difficult time fighting to receive compensation for an injury I found some comfort in the reassurance that I was not fighting alone. Alex and Michal kept me up to date with what was going on and what steps were next to move forward. During the mediation process Alex navigated this situation strategically at the same time reassuring me that we would leave with some success.

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