Recently, three separate ERISA actions were filed against Aetna in Federal Court for wrongfully denying disability benefits to those covered under Aetna Long Term Disability Policies. Lets take a closer look at each of these cases.
Case 1: Bank of America Employee
Vanessa B. and her Texas disability lawyer filed a lawsuit against Aetna Life Insurance Company in the United States District Court for the Northern District of Texas Dallas Division on September 16, 2011 for unpaid disability benefits. Vanessa B., a Bank of America Corporation occupational projects analyst became disabled and unable to continue work on March 1, 2010. Diagnosed with lumbar spinal abnormalities, fibromyalgia and chronic pain syndrome, Vanessa B. applied for her long term Aetna disability benefits but was denied her claim on August 30, 2010. Her denial letter from Aetna stated that Vanessa B. had not provided the insurer with adequate medical records to support a determination of disability rising to the level of disbursement of long term disability benefits. Consequently, Vanessa B. appealed the insurer’s decision and provided additional medical records to no avail.
With no viable option but to file a lawsuit, Vanessa B. employed the services of a disability attorney to bring her case to Court. In the complaint filed in District Court, Vanessa B.’s disability lawyer accuses Aetna of engaging in “conduct not consistent with its fiduciary due to [Vanessa B.] under ERISA and in violation of provision of ERISA and regulations and other requirements promulgated pursuant to ERISA and to the extent of any discretion, abused such discretion” when denying Vanessa B.’s claim. Her attorney claims that the insurer did not fully and fairly evaluate Vanessa B.’s claim and did not properly take into consideration Vanessa B.’s medical documentation of her disability. Thus, Vanessa B. and her disability attorney petition the Court to grant Vanessa B. her entitled long term disability benefits, prejudgment interest, attorney’s fees and expenses and court costs as well as any other appropriate relief from the insurer.
Case 2: Boeing Employee
A beneficiary of an employee benefits plan since January 1, 1999, Aetna Claimant Vanessa M. was shocked that when she needed to make use of her disability benefits, the insurer would arbitrarily terminate her disability benefits. A 44-year-old Tooling Integrated Analyst for Boeing, Vanessa M. stopped working in March 2009 due to degeneration of her lumbar disc, post laminectomy syndrome and lumbar spondylosis. Vanessa M. was originally awarded her short term disability benefits from Aetna but those benefits were terminated in September 2009; and Vanessa M. applied for her long term disability benefits, which were denied.
Claimant Is Denied Disability Benefits on Her Appeal to Aetna’s Initial Denial
Vanessa M. proceeded to appeal the insurer’s decision to deny her long term disability benefits by taking advantage of Aetna’s administrative appeal process and requested an administrative review of her denial of disability benefits. She supplied the insurer with her medical records, verifying her totally disabled condition as well as verification that she had been declared “disabled” by the Social Security Administration (SSA) and is eligible for Social Security Disability Benefits under Title II and Title VI of the Social Security Act. Not swayed from its earlier decision, Aetna made its final denial of Vanessa M.’s claim and since Vanessa M. had exhausted all other options for appealing to the insurer for her disability benefits, she hired a Washington state disability attorney to file a complaint against Aetna and Boeing in the United States District Court for the Western District of Washington Seattle Division on September 16, 2011.
Vanessa M. and Her Disability Attorney File Complaint Under ERISA Violations
In the complaint, Vanessa M. attorney describes Vanessa as a person who “suffers from multiple bulged discs, sciatica, post laminectomy syndrome, radiculitis and degenerative disc disease.” As a result of these medical conditions Vanessa M. is limited in her activity level, is in chronic pain and discomfort, and takes multiple medications for her symptoms which have narcotic side effects. Consequently, Vanessa M.’s attorney laments that Vanessa is so severely impaired that she cannot “maintain the pace, persistence and concentration required to maintain competitive employment…”
In the complaint Vanessa M. and her attorney ask the District Court to affirm that Aetna has wrongfully denied Vanessa M.’s disability benefits in violation of the Employee Retirement Income Security Act of 1974 (ERISA) and award her:
- Declaratory and injunctive relief by finding her entitled to “all past due short term and long term disability benefits yet unpaid under the terms of [her] Plan”; and
- Reasonable attorney fees and expenses incurred due to the insurer’s wrongful denial of her coverage.
Case 3: Sheet Metal Worker, Welder, and Pipefitter for Cytec Industries
Twenty-year Sheet Metal Worker, Welder, and Pipefitter for Cytec Industries, Inc., Jeffrey M. and his West Virginia disability attorney are suing Aetna Life and his employer for denied disability benefits in the Wood County Circuit Court Parkersburg, West Virginia. Suffering from end-stage renal failure, Jeffrey M. underwent kidney dialysis and a kidney transplant in September 2007. After the transplant, Jeffrey M. began suffering from “hypertension, coronary artery disease, high cholesterol, gastroesophageal reflux disease and an inoperable hernia, and consequently, was unable to return to work.
Jeffrey M. applied for and received short-term disability benefits under his Aetna ERISA-governed disability plan from May 2007 until November 2007. Continuing to be disabled, Jeffrey M. applied and received his Aetna long term disability benefits; but in July 2010, Aetna informed Jeffrey M. that he “no longer qualified for long-term disability benefits under his Cytec policy” and his disability benefits were terminated.
Aetna Justifies Its Denial of Disability Benefits by Alleging Claimant Can Work
The insurer justified its decision by stating that while it agreed that Jeffrey M. could no longer perform as a sheet metal worker, welder, and pipefitter, the insurer determined that he could function at some other occupation. And, Jeffrey M.’s physician had released him to light duty work, but unfortunately, Cytec had no such work to give to Jeffrey M., and the insurer had no suggestions as to where Jeffrey M. might find such employment. The Social Security Administration did find Jeffrey M. disabled and awarded him SSDB (Social Security Disability Benefits retroactively beginning in November 2007. However, claiming it used a “separate standard” from the SSA for determining disability, Aetna continues to deny Jeffrey M. his Aetna disability benefits. After exhausting all administrative appeals available to him, Jeffrey M. hired a disability lawyer and filed the subject complaint.
Aetna Must Prove that Jeffrey M. Is Capable of Earning 80% of His Previous Income to Deny Him Disability Benefits
To be able to deny Jeffrey M. his disability benefits, Aetna must show that Jeffrey M. is capable of actually earning at least 80% of his “adjusted pre-disability wages,” which he cannot do in his local marketplace given his education, experience, and skill level, meaning that Aetna appears to have no grounds for denying Jeffrey M. his entitled disability benefits. Therefore, in the complaint Jeffrey M. and his disability attorney ask the Court to allow Jeffrey M. to recover his monthly ongoing disability benefits from Aetna as well as his past-due payments, attorney’s fees, pre-judgment interest, cost of suit and any other relief the Court “deems appropriate.”