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Aetna Is Sued For Failure To Pay ERISA Benefits To Boeing Employee For Injuries Sustained In A Shooting

A Washington disability lawyer filed a federal lawsuit in the District Court for the Western District of Washington, at Seattle, against Aetna Life Insurance Company (Aetna) and The Boeing Company Long Term Disability Plan (Boeing). The Plaintiff, Patrick D., worked as a real-time software engineer for Boeing, which contracted with Aetna to provide long-term disability coverage to its employees. The Plaintiff’s employment with Boeing afforded him the protections under this Plan.

In Patrick D. v. Aetna Life Insurance Company and The Boeing Company Long Term Disability Plan, Plaintiff has filed a lawsuit to recover long-term disability benefits protected under ERISA.

Case Facts Against Aetna And Boeing

Plaintiff had been employed by Boeing since 1989, including working as a real-time software engineer. He had received exemplary reviews on his performance as a real-time software engineer.

In 1971, the Plaintiff had been a victim of a shooting that caused massive damage to his face and head. As a result, the Plaintiff has had to undergo repeated surgeries over a 22-year period, including a 17-hour surgery to his head in 1996.

After this 1996 surgery, the Plaintiff’s performance had declined from exemplary to unsatisfactorily. In 2007, a performance appraisal stated that the Plaintiff was less than one-fourth as productive as the typical employee in his position. After this appraisal, Plaintiff consulted The Boeing Company’s Employee Assistance Program (EAP), who advises him to go onto disability and seek professional help to diagnose and possibly alleviate the problems that were hindering his work production. In June 2007, Plaintiff quit work and applied for disability benefits. Aetna initially granted Plaintiff’s claim for short term disability benefits.

Aetna’s Termination Of Further Benefits

However, beginning September 1, 2007, Aetna terminated Plaintiff’s short term disability benefits. Plaintiff submitted an appeal on October 31, 2007, including explanations of his condition, X-Rays, and documentation from his care providers. Aetna responded by providing an additional 10 days of short term disability benefits through September 11, 2007, but nothing more.

Plaintiff submits second appeal of the denial of benefits on March 30, 2008, along with documentation from his treating physicians and the results from a comprehensive neuropsychological evaluation conducted by neuropsychologist Glenn Goodwin, Ph.D. in February 2008. Aetna responded by restoring his short term disability benefits through the maximum duration of the short term disability period, which was December 13, 2007. Aetna also stated that his file had been returned to the claim team for “further case management.”

However, via letter on August 5, 2008, Aetna informed Plaintiff that long term disability benefits were again denied due to Plaintiff’s pharmacy not establishing that his disability was not the result of a pre-existing condition. On August 12, 2008, Aetna received a letter from the Plaintiff that included all pharmacy records to help Aetna make a determination on whether Plaintiff’s condition was a pre-existing condition or not.

On September 18, 2008, Plaintiff received a letter from Aetna, who acknowledged that the pre-existing condition exclusion did not apply to the Plaintiff’s case, but still denied long term disability benefits because the results from the February 2008 neuropsychological evaluation were determined to be too “stale” to establish Plaintiff’s disability beginning May 8, 2008.

Plaintiff submitted an appeal in April 2009 that included additional medical documentation to establish Plaintiff’s claim. Via letter on June 23, 2009, Aetna again restored benefits effective May 1, 2008. However, these benefits were again terminated as of December 13, 2009 due to Plaintiff’s disability being caused by a mental illness, which only allows for benefits to be paid for 24 months, ending December 13, 2009.

Plaintiff files another appeal that includes another detailed report by neurologist Gregory Hipskind and treatment records from his treating neurologist, Dr. Gary Stobbe. In response, Aetna had Joseph Rea, M.D., examine the Plaintiff’s medical file, though there is no evidence that Dr. Rea has any training, expertise, or experience addressing neurological issues.

Plaintiff’s Attorney Files Lawsuit Against Aetna

According to the terms of the lawsuit, Plaintiff alleges that Aetna did not provide the following to the Plaintiff:

Plaintiff Seeks Following From Lawsuit Against Aetna

Due to the wrongful actions committed by Aetna, Plaintiffs wants the following relief from the Court:

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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   *****

Jim F.

My employer offered both Short Term Disability and Long Term Disability insurance as optional benefits among others. The premiums were significant, but since they could be payroll deducted I felt they could be reasonably managed and the security of continued income in the event of a medical disability was well worth the investment. As with the purchase of a first aid kit, most would prefer never having to use it.

I have been very fortunate to have had few illnesses or injuries throughout my life and more specifically my 45 year career as a healthcare professional. It wasn’t until early in 2012 that I was diagnosed with a chronic, progressive disease of the eye. Symptoms were minimal at that time, though regular visits to a retinal specialist, including regular therapy by ocular injection, were necessary to slow its progression, the symptoms did not appreciably interfere with my work. In spite of my treatments the condition continued to progress. In early 2014 the symptoms began to interfere dramatically with my day to day duties. My job required significant computer use and the reading of copious amounts of medical documentation. It became evident to me that I could no longer meet the expectation of my management and clinical position without working frighteningly long hours and enduring the relentless eye strain and other symptoms related to the illness.

Though I had always planned for eventual retirement from my full-time position, like most professionals I had hoped to be able to continue to practice my profession on a part-time basis throughout my retirement as long as I remained competent and able. That was not to be. Thankfully, I had the foresight to elect the disability benefit options offered by my company and have the premiums payroll deducted for many years. I notified my supervisor and HR representative that I had to stop working due to my condition and proceed with the disability application process.

All went very well and after using up my accrued vacation and sick time, my short-term disability benefits commenced. Since my condition is progressive and incurable I felt secure in knowing that once my short-term benefits were exhausted my benefits would continue under the long-term policy. However, much to my surprise, after receiving about a month of benefits I received notification from the insurance company that a decision had been made to terminate my benefits due to lack of objective medical evidence to support my claim, though significant documentation had been provided by my retinal specialist.

I was bewildered and unsure of how to proceed with an appeal of that decision. Since I had 180 days to do so, I decided to research the matter thoroughly. In spite of my being a veteran healthcare professional everything I had been reading on the subject cautioned about attempting to proceed with an appeal on my own. Legal representation was highly recommended.

I then began a review of local attorneys, hoping to find one that provided enough documentation on their website that indicated experience with non-social security disability related cases. I was also interested in seeing evidence of some experience with disability cases related to diseases of the eye and resultant vision impairment. I was unsuccessful.

So I expanded my search to include national law firms. It was then that I discovered Dell & Schaefer. After thoroughly reviewing their website, watching many of the video discussions, noting experience with vision related cases, particular documentation related to the insurance company that handled and then eventually denied my benefits, and reading a significant number of testimonials, I decided to request a free consultation as advertised. It was one of the best decisions I have ever made.

After that consultation, I was very confident that I was in very skilled hands which alone reduced my anxiety level immensely. Attorney Alexander Palamara and his Legal Assistant, Kathleen Bordes, immediately began managing my case, their professional expertise clearly evident.

They worked closely with my retinal specialist, my optometrist and the insurance company in compiling the medical documentation necessary for a successful appeal in an amazingly short period of time, keeping me fully informed all along the way. Shortly after being notified by the insurance company that my benefits would be reinstated and paid through the full term of my short-term policy I received a lump-sum payment.

Once the short-term disability appeal was successfully completed, Alex and Kathy immediately addressed the long-term policy benefits. Again in a remarkably short period of time I was granted those benefits, receiving a lump-sum payment for benefits to date and will receive a payment monthly going forward per the terms of my LTD policy.

I am extremely pleased with how my case was handled and the very favorable outcome. Alex and Kathy were a delight to work with and extremely professional in every way. Incidentally, the fee I paid to Dell and Schaefer for their incredible representation was very reasonable and very well earned.

I highly recommend the services of Dell & Schaefer to anyone who may find themselves in a similar disability-related situation.

***** 5 stars based on 202 reviews

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