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 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.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

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