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:
- A complete review of the plaintiff’s administrative record of her claim for short term and long term disability benefits.
- Render judgement against Aetna for damages in an amount determined to be reasonable.
- Declaration that the plaintiff is entitled to long term disability benefits
- An Award of attorneys’ fees & costs and interest
- Any further relief deem just and proper by the Court