Two Plaintiffs filed cases against Aetna Life Insurance Company (Aetna) in the Maine and California District Courts due to the failure to provide disability benefits provided by the Employee Retirement Income Security Act (ERISA) of 1974. In the previously mentioned cases filed through the plaintiffs’ disability lawyers, it is alleged that Aetna has wrongfully denied the Plaintiffs’ claims for disability benefits as provided by the terms of those respective plans.
First Case – Maine
In Bonnie R. Vs. Huhtamaki, Inc. and Aetna Life Insurance Company, the Plaintiff filed an ERISA lawsuit in the District Court of Maine via a Maine disability attorney against the Defendants for failure to provide disability benefits covered by ERISA. Plaintiff was hired by Huhtamaki, Inc., a specialty packaging and consumer food service product manufacturer, as a rough finisher with the “Rough Finish Dry End Crew” (Rough Finish). Due to her employment, Plaintiff was covered by the Huhtamaki TDI plan, which was insured by Aetna.
Plaintiff filed a report on February 18, 2010 stating that she could no longer work for the “Rough Finish Dry End Crew” due to continuing sexual harassment and retaliation against her by other Rough Finish workers that led to Plaintiff developing depression, anxiety, a psychological breakdown, and post traumatic stress disorder (PTSD).
Despite continuing treatments and psychological counseling sessions from February to September 2010, the Plaintiff had not made enough progress to resume working in a factory setting according to her psychological counselor, Patricia G., LCSW (Ms. G.) and her primary care physician, Dr. Susan C. (Dr. C.). As a result, Ms. G. and Dr. C both completed Aetna’s Attending Physician’s Statement, stating that Plaintiff could not return to factory work with Huhtamaki.
On April 2, 2010, Aetna denied her claim for benefits under the Plan as provided by Aetna. Plaintiff filed an administrative appeal of that decision, but that appeal was denied by letter by Aetna on July 21, 2010, based largely on the opinion of Aetna’s own peer physician, Elana Mendelssohn, Psy.D., who never examined the Plaintiff. On April 25, 2011, a letter was sent from Aetna to the Plaintiff stating that no further review of Plaintiff’s claim would be examined. Due to the Plaintiff exhausting her administrative appeals, Plaintiff has filed this lawsuit against Aetna.
The Second Case – California
In Mary S. Vs. Aetna Life Insurance Company, Bank of America Corporation Short Term Disability Plan (Bank of America), the lawsuit was filed via a disability attorney in the District Court of the Central District of California. Plaintiff was employed by Bank of America as a Claims Administrator and Senior Vice President of the Home Loans Division for Bank of America Corporation and was covered under Bank of America’s short-term disability plan, which was believed to be funded by Aetna.
Plaintiff had a two-year history of left eye twitching that started in October 2008. She was treated with Botox, which helped to stop the twitching. However, the Botox treatment in February 2011 caused complications that led to slurred speech and hypersensitivity above her left eye, popping in her left ear, ear pain, and headaches above the eye.
Plaintiff became totally disabled and was on medical leave between March 4, 2011 and March 8, 2011. Aetna denied Plaintiff’s claim due to a lack of medical evidence to support the Plaintiff’s inability to perform the essential functions of her own occupation. This was despite the fact that Plaintiff’s treating physician, Dr. Cher C. , M.D. (Dr. C.), extended Plaintiff’s medical leave from March 28, 2011 through April 11, 2011.
On March 29, 2011, Plaintiff faxed a written appeal of this decision to Aetna, including a letter from Dr. C. from March 28, 2011 that stated that Plaintiff needed time off work to overcome her increasing anxiety, in the appeal. Aetna requested more information on April 1 and 19, 2011 and on May 4 and 18, 2011. Dr. C. again extended Plaintiff’s medical leave from April 11, 2011 through May 9, 2011.
Aetna had conducted peer reviews with Dr. C. between April 2011 to July 2011. Aetna’s physicians were unconvinced that Plaintiff had visual impairment that would keep her from working in her occupation, eventually leading to Aetna denying Plaintiff’s appeal on July 29, 2011.
Following Relief Sought In Filed Lawsuits
In the two previously mentioned cases, the Plaintiffs request that the following relief from Aetna is granted:
- Damages for violations of the terms of the respective plans for providing disability benefits as provided by ERISA;
- All benefits as provided under the respective plans, along with accrued interest;
- All associated court costs and attorney fees;
- All other relief that the Court finds to be proper and just.