After Aetna denied Ms. Garner’s long-term disability claim, Ms. Garner filed suit against Aetna, and the Court overturned Aetna’s decision and ordered it to pay Ms. Garner’s disability benefits

In 2004, Sally took a leave of absence from her job as an import supervisor for a global shipping company to undergo surgery for an internal left knee derangement. During that time she had also been suffering from severe symptoms of depression following her son’s departure to college and the at-home environment changing. Her doctors diagnosed her with bipolar disorder II and placed her on depression and anxiety medications.

Sally promptly filed claims under her private long-term disability insurance with Unum Life Insurance Company and her group long-term disability insurer, Aetna Life Insurance Company. Unum approved her long-term disability claim and began issuing disability benefits following the 90 day elimination period. Aetna also approved her short-term disability claim; however, after 180 days, at the point that her short-term disability claim was to pass into her long-term claim, it notified Sally that her benefits were being terminated.

Shortly after she had stopped working, Sally underwent knee surgery and began physical therapy with the hopes of recovering and returning to work. However, her pain persisted after surgery, which increased her sadness and hopes of once again living a pain free normal life. Adding insult to injury she also now faced having to appeal Aetna’s erroneous decision to deny her long-term disability benefits, despite her doctor advising her physical disability were permanent and would never improve to where Sally would be capable of returning to sedentary employment.

Sally and her husband met with Attorney Cesar Gavidia to discuss their options relating to Aetna’s denial of her claim. In its denial letter, Aetna claimed that Sally was no longer disabled for failing to submit sufficient proof of loss, and that it had not received sufficient information to support restrictions and limitations. Aetna informed Sally that if she disagreed with the decision she could appeal the decision within 180 days.

Attorney Gavidia prepared Sally’s Appeal addressing both her physical and mental limitations. It was important to establish that Sally’s physical limitations were the primary cause of her disability, and aggravated her long-standing mental health issues. However, by themselves, her physical conditions caused her to be totally disabled. After receiving the Appeal Aetna overturned its decision and reinstated Sally’s disability claim.

For the next 13 years, Sally received long-term disability benefits with the help of Attorney Gavidia. He navigated her claim through the transition from Own Occupation to Any Gainful Occupation, after she had received benefits for 24 months. He managed every aspect of her claim including the completion and submission of claim forms and attending physician forms, and was the only point of communication for Aetna, so that they could not reach out directly to Sally to coerce into statements that could jeopardize her right to receive her disability benefits.

In 2018, 13 years after Attorney Gavidia had successfully appealed her disability claim, Sally reached age 65 and the maximum benefit period under her Aetna Group Long-term Disability Policy. Please call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.

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FAQ

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.

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