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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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.

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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.

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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.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

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Paul L. (New York)

Words can only scratch the surface regarding my experience working with Attorneys Dell & Schaefer. It’s a very emotional experience making the decision to utilize disability insurance. The unknowns were/are scary. From the very first phone call, the support staff was/are very professional and reassuring. I have been working with Attorney Steven Dell for approximately 10 years. He is confident, reassuring, listens to and addresses all my concern, and is extremely dilligent in understanding my specific policies for how they impact me. It is very reassuring that Steven handles and deals with the insurance company on my behalf. Attorney Dell’s team, and specifically Merlin, Attorney Dell’s assistant, is simply fantastic. Her professionalism and attention to detail have made all my communications with the office seamless.

Simply put, my experience with Dell & Schaefer made the emotional rollercoaster experience of my neck surgery seem like a walk in the park.

Thank You, Thank You, Thank You, to both Attorney Steven Dell and to Merlin for how you have helped me over these past 10 years.

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With 10 years experience with working with Dell & Schaefer, taking that step to call Attorneys Dell & Schaefer was one of the best professional and personal decisions I have ever made.

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