Aetna Reinstates Short and Long Term Disability Benefits on Appeal to Warehouse Manager Suffering from Major Depression

Prior to filing for disability benefits our client was in charge for the day to day operations of a large warehouse; responsible for inventory, shipments, deliveries, compliance and supervision of all employees within the warehouse. If this wasn’t enough he was responsible for these duties for all three work shifts. During the course of his employment he was stricken with cancer, and although he was “cured” his physical and emotional health would continue to suffer. Despite his efforts to return to work, he continued to suffer from ongoing fatigue and cognitive difficulties. Before too long his mental health had decompensated to the point that he was afraid to leave his house, was highly suspicious of others, incredibly anxious, and unable to maintain normal social relationships or interact with others. Unable to get out of bed or leave his home due to his escalating depression and panic attacks, he filed for disability benefits with Aetna.

Short Term Disability

Our client’s claim for short term disability benefits with Aetna was initially approved. For a period of the benefit term it seemed as if Aetna was not going to contest or challenge the sufficiency of the medical information provided by his psychiatrist and psychologist. However, as the remaining timeframe for short term disability benefits began to dwindle, Aetna increased the level of scrutiny on his claim. With only a couple weeks of short term disability benefits left, Aetna terminated our clients claim, and in doing so would effectively deny his claim for long term disability benefits on account of it.

Long Term Disability

Prior to the denial of short term disability benefits, our client submitted claim forms to begin a review for his entitlement to long term disability benefits under his employer’s policy. However, due to the fact his long term disability benefits were contingent upon him being disabled throughout the Elimination Period, which coincided with his claim for short term disability benefits, and his claim was denied for the remainder of his short term disability benefit, the long term disability claim followed suit and denied his claim for not satisfying the Elimination Period.

The Appeals

Following the receipt of two denial letters, our client contacted Attorneys Dell & Schaefer and consulted with Attorney Stephen Jessup. Following review of our client’s short and long term disability policies and the denial letters Attorney Jessup explained that the “type” of denial our client experienced was not uncommon. Specifically, Attorney Jessup noted that the short term disability policy was funded by the employer, which meant Aetna was not paying the monthly benefit. However, the long term disability policy was funded through the assets of Aetna, and with that came a financial incentive to deny the claim. By denying the short term disability benefit, Aetna had an easy road to deny long term disability benefits, and more importantly save money.

Attorney Jessup set to get complete copies of both the STD and LTD claim files. Review of same indicated that there was a disconnect in the sharing of information between the short and long term disability departments. What was even clearer was the fact that Aetna was discounting and ignoring the opinions of our client’s mental health providers and instead focusing on what it deemed to be a lack of clinical evidence. Armed with the reports of Aetna’s reviewing doctors, Attorney Jessup drafted specific questionnaires for our client’s treatment providers to complete in an effort to better document our client’s restrictions and limitations. Upon receipt of all updated medical information and additional support of disability, Attorney Jessup filed appeals to the short and long term denials.

The Approval

Despite an overwhelming amount of support that indicated our client could not perform the duties of his occupation, Aetna did not reach a decision on the appeal within the first 45 days and pursuant to ERISA requested an extension of 45 days. During the extension period, benefits for short term disability benefits were approved. However, it was still some time before Aetna made a decision on benefits for long term disability benefits. As the deadline to render a decision loomed, Aetna issued an initial approval of long term disability benefits for a limited period of time, and then denied future benefits. Normally this would prompt the right to another appeal; however, Aetna informed our client his only option was to bring civil action under ERISA. Acting swiftly, Attorney Jessup filed suit in Federal Court. In the interim, Aetna failed to provide the long term disability benefits for the period they initially approved. Attorney Jessup and his staff continually contacted Aetna to inquire as to the status of these benefits. It was during these communications that Aetna re-evaluated the appeal decision and advised Attorney Jessup that it was in fact approving our client’s claim for continued benefits without the need for additional legal action.

To What End…

…will an insurance company make you fight for your benefits? In this case – repeatedly in the hope that you will give up on the benefits you are entitled to and walk away. If your claim is being contested or challenged by your insurance carrier, please do not hesitate to contact Attorneys Dell & Schaefer at 1-800-828-7583 for a free consultation to determine how we may be able to assist you.

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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.

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