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Court grants partial summary judgment in favor of Plaintiff, remanding claim back to Aetna to review records it failed to review during the appeals process

In the case of Cannon v. Aetna Life Insurance Company, a Massachusetts Court found that Aetna abused its discretion in denying LTD benefits to a pharmacist with Lyme Disease. The Plaintiff argued that Aetna failed to provide specific documents during the administrative appeal process, such as the entire claim file, which calls into question the integrity of Aetna’s decision to deny his benefits.

Why is Aetna required to provide the complete claim file to a claimant upon request?

Most group disability plans are governed by The Employee Retirement Income Security Act (“ERISA”). This act affords certain rights to claimants who are disabled and claiming rights to benefits under their STD and LTD plans. Specifically, ERISA states: “every employee benefit plan shall afford a reasonable opportunity to any participant whose claim for benefits had been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.”

In Cannon, the Plaintiff argued that he was not provided a full and fair review since Aetna failed to provide him the complete claim file upon request. If he had received the complete claim file, he would have been able to determine that Aetna failed to provide all of the records requested by its peer review physician needed in order to make a fair decision on his claim. If he had known these records were never provided, he would have sent them to Aetna to provide to the reviewing physician. However, by the time the Plaintiff had discovered this information was never sent, the final decision was already rendered by Aetna and his administrative record was closed. The court agreed that the failure to provide the entire claim file was clearly prejudicial to the Plaintiffs claim. The court remanded the claim back to Aetna for further review.

When your claim is denied by your insurance company, it is pertinent to request your complete claim file in order to determine exactly what your insurance company did during the review process of your claim. As seen above, the failure to review the claim file prior to the close of your claim can cost you your benefits.

– Read more about Lyme Disease disability claims and view user comments on this page.
– For Aetna cases and user reviews, click here.

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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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