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Court Orders Aetna to Reconsider Termination of Disability Benefits Where Aetna Completely Ignored Treating Doctors Records and Recommendations

In Valentine v. Aetna Life Insurance Company, the plaintiff applied for disability benefits claiming her disability began in December 2011, when she was diagnosed with trigeminal neuralgia which caused her severe facial pain. She also claimed that her pain medications had side effects that made it impossible for her to concentrate and perform her job duties. Her claim was accompanied by medical records from her treating physician, Dr. Sirois, a specialist in cranial nerve injuries.

Her claim was denied and she filed an administrative appeal which prompted Aetna to hire a Physical Medicine and Rehabilitation specialist, Dr. Rubin, to review her medical records. In his report, issued in January 2013, Rubin stated he reviewed medical records from the date of her claim through March 30, 2012. He concluded that the records supported “functional impairment” and that “it is reasonable that these impairments will continue for another three months through 6/30/12.”

Based on that report, Aetna granted Valentine disability benefits from the date she filed her claim through June 30, 2012, at which time her long term disability benefits were terminated. Valentine then filed this ERISA lawsuit.

Federal District Court Finds Valentine Submitted Substantial Supporting Evidence That Was Not Adequately Addressed by Aetna When It Terminated Her Benefits

The District Court relied on precedent established in 2013 by the U.S. Court of Appeals for the Second Circuit which held that a plan administrator must base its decision on a full review of the entire evidentiary record and cannot ignore evidence favorable to the claimant. Comparing that case to Valentine’s, the district court commented that for Aetna to accept plaintiff’s claim for benefits through June 30, 2012, based on Dr. Rubin’s report, and deny her benefits after that “is utterly perplexing when compared to the administrative record.”

The court found Rubin’s report claiming there was no evidence to support disability after the June 30 date “entirely inconsistent with the overall administrative record.” Rubin’s report ignored records of multiple office visits and medical evaluations submitted by Valentine’s treating physician in November 2012 which verified Valentine was still suffering from the same symptoms and limitations as she had suffered from when Rubin determined she should be granted benefits. Rubin’s report also overlooked a November 29, 2012, evaluation report by a vocational expert who agreed with Dr. Sirois’s assessment that Valentine was impaired to a degree that she could not perform her job. Not only did Aetna’s consultant, Rubin, ignore these records, Aetna did not mention them at all in its termination letter.

The court remanded to Aetna concluding that Aetna’s termination of benefits “failed to address substantial evidence in the record.” It ordered Aetna to reconsider its decision based on all the evidence in the administrative record.

Although this case was not handled by our office, we thought it may provide guidance for claimant’s with similar issues. If you need assistance with your disability claim, administrative appeal or ERISA lawsuit, contact any of our lawyers for a free consultation.

You can read more about Aetna cases on this page.

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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.

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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.

Dell & Schaefer Client Reviews   *****

Jeanne E. (New York)

My experience with Dell & Schaefer has been entirely positive. I presented Mr. Pena, Ms. Arriaga, and Ms. Rodriguez with a meritorious appeal and virtually no time to present it. In less than 3 weeks, they identified the critical points to present for my appeal, collected the supporting documentation, and crafted a compelling and convincing argument in presenting my appeal.

I was of virtually no help to Mr. Peña and his staff. I forgot tasks, large and small. assigned to me to carry out. They worked around my obstructive assistance to compile a compelling argument and supportive documentation to present to my disability insurer.

As an attorney, my initial instinct was to attempt to micromanage the conduct of my appeal. Mr. Pena and his staff quickly demonstrated such extensive knowledge and experience in dealing with private disability insurance that the control freak in me recognized I should stand back and let them do what they do so very well.

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