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Long time Bank of America employee sues AETNA for denial of disability benefits

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.

Comments (8)

  • PB,

    Have you received the formal denial letter? If so, please feel free to contact our office with a copy of same to discuss your case in detail.

    Stephen Jessup Jan 11, 2016  #8

  • It is clear that Aetna works for Bank of America, and Aetna has no interest in helping employees. I received STD which is ending Jan 10 2016. I applied for LTD early in Dec. 2015 and heard nothing from Aetna until Jan. 8, 2016. My Doctor has stated she does not want me to go back to work yet, and Aetna denies my claim. It is clear that Aetna bases it decisions on their opinion and not medical facts.

    PB Jan 10, 2016  #7

  • K,

    Have you filed an appeal of the denial? If not, please feel free to contact our office to discuss your husbandโ€™s claim in greater detail and how we may be able to assist him.

    Stephen Jessup Feb 4, 2015  #6

  • My husband went through the same thing denial of his short term disability. Finally, we did get that approved in October but then October was 6 months so now it moves to Long Term and yes they have denied it. It is now February and he still hasn’t been approved.

    K. Rodgers Feb 3, 2015  #5

  • I would like to provide an up date Bank of America has outsourced much of its HR functions to Aetna and Hewitt, they work hand in hand. So though you my think it’s Aetna, consider it may also be Bank of America. This at first they denied through Advice and counsel but then verified through our employee hand book which says Bank of America delegates authority to Aetna. I have come to find out in this aspect they are one and the same, which is why I was allowed to proceed through the EEOC.

    It took some time to explain this relationship, but it finally got through and was enough to get the Bank to mediation and take corrective action.

    Jesse Alicea Jun 24, 2014  #4

  • Shima,

    Please feel free to contact our office to discuss how we may be able to assist you in appealing the decision.

    Stephen Jessup Nov 12, 2013  #3

  • I have been a short term disability for 5 months. My claim was approved until they denied me in October. I struggle with depression and anxiety. Aetna said that the reason why they denied because I was able to give the doctor eye contact.

    Shima Nov 11, 2013  #2

  • This issue is wide spread, it has happened to me as well, but as I found out it’s not only an ERISA issue, it’s also a violation of the American with disabilities act. Employers are responsible for discriminatory actions against their employees. Even deceptive practices that tend to harm disabled people covered under the ADA. People need to start going after the employers of these companies.

    Jesse Alicea Sep 10, 2013  #1

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