Filing a lawsuit under ERISA (the Employee Retirement Insurance Security Act of 1974) against AETNA, Leslie R, and her Arizona disability lawyer accuse the insurer of operating under a conflict of interest in the denial of Leslie R.’s short term disability benefits. As the decision maker and payor of benefits, AETNA has a bias toward denying benefits. And, according to Leslie R.’s disability lawyer in such incidents like Leslie R., the insurer is inclined to deny short term disability benefits in an effort to not have to follow through with long term disability benefits payments.
A long-time employee at Bank of America, Leslie R. became disabled due to some serious medical conditions and was unable to continuing work as a customer service & sales specialist for the company.
History of Claimant’s Disability and Denial of Benefits by AETNA
After applying for short term disability benefits and being denied again and again through the AETNA appeal process, Leslie R. submitted her medical records to prove that she qualifies as disabled per the terms of her insurance policy. Leslie R. and her disability lawyer claim that the insurer engaged the services of a particular physician to review her claims and that the reviewing physician has “an incentive to protect his consulting relationship” with the insurance industry and “Aetna by providing medical review reports which selectively review or ignore evidence” in cases such as Leslie R.’s. They accuse AETNA of violating ERISA (the Employee Retirement Insurance Security Act of 1974) in that the reviewing physician “did not have the relevant medical expertise and was not the appropriate medical professional to evaluate” Leslie R.’s disability diagnoses and limitation revealed in her claim. Thus, they accuse the insurer of not providing Leslie R. with a full and fair review of her disability benefits claim.
According to the lawsuit, Leslie R. has been unable to engage in any occupation, which is continuing and ongoing, and she thinks the insurer denied her short term disability claim in an arbitrary fashion. Her lawyer believes that AETNA violated ERISA because the insurer engaged a reviewer who disregarded the medical evidence of his client’s disability, failed to obtain an independent medical opinion about this case, and consequently unfairly denied Leslie R.’s claim. And, as a result of not adequately reviewing the subject claim, AETNA squashed any chance of Leslie R. having the ability to collect her long term disability benefits, or even apply for them.
Disability Lawyer Accuses Aetna of Not Fulfilling Contractual Obligations to Claimants
In essence, this lawsuit accuses the insurer of not fulfilling its contractual obligation to Leslie R. to determine the validity of her claims “solely in her best interests and other participants.” They ask the United States District Court of Arizona to review Leslie R.’s evidence and order the recovery of damages to compensate her for the injury she has suffered and continues to suffer as a result of her disability. And, Leslie R. and her lawyer also request that the Court determine through litigation that she is indeed eligible to receive her long term disability benefits, recover all unpaid benefits, prejudgment interest, reasonable attorney’s fees and cost of filing the subject lawsuit.