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Disability attorney sues Aetna Life Insurance for failure to pay short term disability benefits to Huhtamaki Americas employee

A disability attorney recently filed a lawsuit in the District Court for the district of Maine against the Aetna Life Insurance Company (Aetna). In Bonnie Ramsdell vs Huhtamaki Americas, Inc and Aetna Life Insurance Company, the plaintiff, suffering with post traumatic stress disorder brought the disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover short and long term disability benefits that were wrongfully denied by Aetna.

Aetna Denies Disability Benefits

The plaintiff Bonnie Ramsdell was employed by Huhtamaki Americas, Inc who is a manufacturer of specialty packaging and consumer food service products as part of the “Rough Finish Dry End Crew”. By virtue of her employment, the plaintiff was covered by the Huhtamaki’s Employee Short Term Disability Plan and Long Term Disability Group Policy. The short term policy provided a weekly benefit of 330.00 in the event that the insured is considered disabled within the disability definition of the plan.

Due to sexual harassment at the workplace, the plaintiff suffered from anxiety, depression, and post traumatic stress disorder (“PTSD”) and was taken out of work on February 18th 2010 until May 24th 2010 by her primary care physician. Despite ongoing treatment, the plaintiff’s primary care physician concluded on November 3rd 2010 that:

It is my clinical impression that Ms. Ransdell’s past and existing symptoms would prevent her from performing factory work. Additionally, I do think that Ms. Ramsdell is unable to work in a similar factory setting anywhere given the extent of her illness and symptoms that have continued.

Denial of Disability Benefits Claim

The plaintiff stated that she was denied her application for short term disability benefits by Aetna on April 2nd 2010. Her appeal was also to the April 2nd 2010 decision which was also denied by Aetna on July 21st 2010 on the grounds provided by the in-house physician review:

Although the claimant’s treating providers opine that the claimant is unable to perform her job duties even in a different work environment, it is my opinion the provided information suggests that the claimant’s emotional distress is circumscribed to her particular work environment and co workers from performing her specific job duties. While it is understandable the claimant would prefer not to return to her reported unpleasant work environment, the information does not substantiate the presence of a functional impairment from 2/18/10 through present.

On April 25th 2010, the plaintiff was informed by Aetna that it was declining further review of the plaintiff’s claim for short term and long term disability benefits and she had exhausted all her administrative remedies.

Disability Lawyer Sues Aetna for denial of Disability Benefits

According to the lawsuit, the plaintiff alleged that Aetna relied excessively on the medical conclusion made by the in-house medical consultant who failed to perform a face to face psychological evaluation and also failed to give weight to the plaintiff’s attending physicians.

The plaintiff also alleged that Aetna failed to comply with the provisions of ERISA by not “…providing a written description of additional material or information necessary for the Plaintiff to perfect the claim and an explanation of why such material or information is necessary…” in the written notice denying her claim for disability benefits.

The plaintiff argued that Aetna’s denial of her claims was erroneous, unreasonable, arbitrary and capricious, and an abuse of discretion. In addition, the plaintiff also contended that Aetna also erred in rejecting the plaintiff’s claim for long term disability benefits because it erroneously denied the Plaintiff’s short term disability benefits.

Relief Sought By The Plaintiff In The Lawsuit

As a result of Aetna’s actions, the plaintiff is seeking the following relief from the Court:

Comments (14)

  • Erin,

    Have you filed an administrative appeal? Please feel free to contact our office to discuss the denial in greater detail.

    Stephen Jessup Jan 18, 2016  #14

  • I applied for short term disability in September. They approved it for one week Oct 14 through Oct 22. But the claim after October 22 was denied. I have been off work with no income and no reason why my STD starting Oct 23 till now was denied when they approved the week prior. My doctor and employer have the STD people everything they needed and I have filled out all of the paper work on time.

    Erin P. Jan 16, 2016  #13

  • Duane,

    If matrix is handling the payment through State provided disability benefits they may be able to. We do not handle state disability insurance claims so we unfortunately would not be able to offer any real guidance.

    Stephen Jessup Jan 6, 2016  #12

  • I pay an amount out of my paycheck for STD to a company called matrix absent management, i am supposed to receive 66.67% of my pay from them, because i work in RI it is mandatory that RI deduct a weekly amount for STD. I am currently on STD and Matrix has approved my claim however they will not issue any checks until RI provides a letter stating what they will pay me, i then need to provide Matrix with this letter so they can calculate there payment to me. I just want to know if Matrix has the right to do this.

    Duane Jan 5, 2016  #11

  • Wanda,

    If you were not eligible for benefits under the LTD on account of not being a covered class of employees then there is very little that can be done. However, you may still have rights to appeal the STD denial. Please feel free to contact our office to discuss your claim in greater detail.

    Stephen Jessup Nov 10, 2015  #10

  • I was on STD, and they stopped it without proper notice. I asked about LTD, they said that I wasn’t eligible because I wasnt a salaried worker. However, they just terminated me on 11/03/15. They never gave me a chance to get better and a chance to return to work. Please contact me as possible. Thank you kindly.

    Wanda D. Nov 9, 2015  #9

  • Jennifer,

    Please feel free to contact our office to discuss your denial.

    Stephen Jessup Sep 11, 2015  #8

  • My short term disability has stopped after I wad paid I have got no funds in 5 weeks. The hospital is just
    saying they need paperwork. I gave them paperwork they needed and still getting runaround. Cigna blames hospital saying they pay you. I was given a return to work date of Aug. 2015 and still not reinstated.

    Jennifer Sep 11, 2015  #7

  • Loretta,

    Have the issued you a formal denial letter? If so please contact our office to discuss how we can assist you in appealing the denial.

    Stephen Jessup Aug 18, 2015  #6

  • I have been diagnosed with generalized anxiety by my psychiatrist and major depression by my psychologist and Aetna life insurance says they don’t have enough information to support my claim.

    Loretta Beach

    Loretta Beach Aug 17, 2015  #5

  • Jamie,

    We would need to know more about your claim in order to potentially assist you. Please feel free to contact our office to discuss same.

    Stephen Jessup May 6, 2015  #4

  • I have been trying to get my claim from pending to whatever their choice may be and now it says it’s suspended. I have had horrible issues with blood pressure and preeclampsia with being pregnant. I am currently 8 1/2 month pregnant and got stuck on bedrest following a hospital stay. I understand I cannot get on fmla in Oregon because I haven’t been with my employer for 12 months…. I’m just curious as if there is anything I can do… It’s been over a month and they keep sending me around the block… I was told by my employer my only option is to quit or get fired. I don’t even know if that is legal either. My doctor has informed me she sent in the paperwork and now my claim is suspended.. I have done all they asked. I guess some advise is what I need.

    Jamie May 5, 2015  #3

  • Robert,

    Please feel free to contact our office to discuss how we may be able to assist you in reinstating your benefit with Aetna.

    Stephen Jessup Aug 6, 2014  #2

  • Aetna has held my short term disability claim in suspended status for 4 weeks now. I have had 4 abdominal surgeries and, 5 ulnar nerve transplantions. I deal with extream chronic pain as a result of all my body has been through. And, I am a single father with 3 dependants. They keep asking for paperwork and, currently have doctor notes that state in black & white that I have a disabilitating condition. I am on the verge of lossing my home because, my condition has over the four years slowly taken it’s toll. And, I have gone through this same problem with Aetna each time I have needed a leave. Please advise. I was forced back to work because, they are refusing to pay. And, I require 15mg of oxycodone every 4 to 6 hours just to function. And, I haven’t once been able to work a full day. Now, I am down again and, I don’t know what to do.

    Robert Smith Aug 5, 2014  #1

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Working with Dell & Schaefer overall was a very pleasant experience. Once I contacted the firm and agreed to representation all of my worries and concerns were handled by the firm. I did not have to deal with the incompetent and deceitful tactics of my policy holders any longer. Dell & Schaefer handled everything; contacting my physicians and putting together all necessary documentation to appeal my denial. I was able to than concentrate on my health issues.

There was minimal contact between Dell & Schaefer and myself. I placed the case in their hands and waited patiently for them to fight for me. Within weeks of submitting my appeal the insurance carrier reversed their decision. Everyone at Dell & Schaefer are extremely professional and compassionate. Whenever I had questions and or concerns they always responded promptly, professionally and compassionately. I am very thankful I turned to Dell & Schaefer in my hour of distress and frustration. I will continue to retain their services to ensure my rightful benefits.

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