• Aetna Denies LTD Benefits To Software Engineer With Cognitive Difficulties Following  A StrokeAetna Denies LTD Benefits To Software Engineer With Cognitive Difficulties Following A Stroke

Attorneys Dell & Schaefer File Lawsuit in Federal Court Against Aetna Life Insurance Company After it Denied Long-term Disability Benefits to Former Software Developer

In 2011, while working as a software developer for a different company, Charles suffered a cerebral vascular attack (CVA). Despite suffering a stroke, after a period of recovery, Charles returned to work, but for a different employer. In 2014 Charles migraines increased and he began having significant problems with his short-term and long-term memory. He also found that he was having significant difficulty performing complex tasks and processing information, all essential requirements of his job.

After visiting with his doctors and undergoing several objective tests including a brain MRI and neuropsychological testing his doctors advised Charles to stop working. Charles’ neuropsychological exam concluded that he indeed suffered from organic brain damage and had a markedly difficult time performing complex and detailed tasks, especially tasks which required visual integration and visual spatial organization. Reluctantly, Charles stopped working and submitted a disability claim to Aetna Life Insurance Company, his employer’s long-term disability insurer.

After submitting his claim application and providing his medical records accompanied by Attending Physician Forms, Aetna approved Charles claim for disability on the basis of his stroke symptoms.

Less than 2 years later and prior to the change in the definition of disability from “own occupation” to “any gainful occupation”, Aetna referred the claim for a medical review and an independent medical examination. The neurologist selected by Aetna to conduct the Independent Medical Examination (IME) examined Charles for 30 minutes and determined that he was not disabled from his own occupation as a software developer. Based on the decision by the IME and the Aetna’s own medical consultant, it terminated Charles’ benefits and closed his claim.

After receiving the letter from Aetna informing him that his claim had been terminated on the basis of the review conducted by its medical consultant and IME physician, Charles hired Attorney Cesar Gavidia and his Appeal team to address Aetna’s denial of benefits. As part of the Appeal, a neuropsychological examination of Charles was conducted, which confirmed and matched the findings from the 2014 neuropsychological report, which was the basis on which Aetna had approved Charles’ disability claim initially. Charles’ medical records, as well as the new neuropsychological report were submitted with his Appeal to Aetna. Approximately a month later Aetna informed Charles that it was upholding its decision to deny his claim.

After exhausting all of his administrative appeals with Aetna, Attorney Gavidia filed a lawsuit against Aetna in federal court in Broward County, Florida, Aetna’s center of operation for group long-term disability insurance claims. The lawsuit alleged that Aetna had violated ERISA by arbitrarily terminating Charles’ long-term disability claim, and not only sought recovery of all benefits owed, but also attorney fees.

Aetna and Charles were ordered by the Court to attend mandatory mediation where both parties, with their attorneys, were required to attempt to resolve the matter. After several hours the parties reached a confidential settlement.

If you believe that your disability insurer may be preparing to begin a review due to a change in your occupational definition of disability, or if you have any questions regarding your long-term disability insurance claim, please feel free to contact Attorney Cesar Gavidia for a free consultation to discuss your options.

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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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