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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.

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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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Rhonda L. (Hawaii)

Gregory Dell has saved my family from bankruptcy. I got sick with Vasculitis and had to undergo 4 years of chemo treatments. I worked during this time as pharmaceutical sales rep. Finally my doctors said that if I did not go on to disability I would die. I went on disability and my company rejected my short term disability. I was in the hospital at the time of the rejection and was not given much time to respond. I live in Hawaii and could not find anyone that would go against my company. They were very big and scared all the attorneys off.

Greg took my case immediately. He got me paid and short and long term disability. After a few years Cigna did a ridiculous review of my claim and said that I should be able to go back to work. At the time I was denied I was currently in a wheelchair and on massive doses of morphine. Vasculitis destroyed all my nerves in the legs and arms. They dropped my long term disability. Greg again went back and fought for my disability and won. My family would be completely bankrupt without Gregory Dell. My doctors said with the stress from all this fighting for my rights has cost me years of my life. But I would not have made it without Greg, Michal and team. Money is not everything but when you are sick fighting to pay your bills and insurance companies really takes a toll. I have recommended Greg and his staff to other disabled persons. I think they are the best. Thanks for everything. You have allowed me to focus on what is important staying alive for my family.

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