Carmen R. and her Florida disability lawyer take AETNA to task in a suit filed on December 19, 2011 in the United States District Court for the Southern District of Florida Fort Lauderdale Division. Claiming AETNA violated ERISA and other employment laws, Carmen and her lawyer accuse the insurer of wrongfully denying Carmen her entitled long term disability benefits after she became unable to perform her job duties as a result of degenerative and traumatic injuries.
She ceased working as a district manager for Dollar Financial Group on March 5, 2009 and at the age of 56 years old was granted her employee short term disability benefits per a policy her employer had procured for her from AETNA.
Claimant Appeals AETNA’s Denial of Long Term Disability Benefits
In October 2009, Carmen R., still disabled, applied for her long term disability benefits from AETNA, was denied those benefits, and took advantage of the 180-day appeal process the insurer offered. If her claim had been approved, Carmen R. would have received $2,617.50 per month in disability benefits. In July, 2010, Carmen R. sought to have her denied benefits reinstated through an appeal, provided additional medical records to prove her disabled condition, and submitted her grant of disability benefits by the Social Security Administration (SSA) to AETNA to no avail. She has now exhausted all of her administrative appeals and was forced to hire a disability lawyer to present her case in District Court.
Claimant’s Complaint and Request for Judgment
In the complaint Carmen R.’s disability attorney claims that AETNA wrongfully denied disability benefits to Carmen R. in violation of ERISA (the Employee Retirement Insurance Security Act 1074, 29 U.S.C. § 1132, and her AETNA plan in that Carmen R.:
- Is totally disabled and cannot perform the duties of her own occupation;
- Was not given a fair denial decision on her claim because AETNA failed to “afford proper weight to the evidence” showing her disability;
- Was not allowed the correct interpretation by reviewers of the definition of disability as it was described in her employee insurance policy language;
- Was arbitrarily, unreasonably, and capriciously denied long term disability benefits; and
- Should contractually receive disability benefits from AETNA.
Consequently in the subject complaint, Carmen R. asks the Court to award her all past due long and short term disability benefits yet unpaid, continuing collection of her disability benefits payments, reasonable reimbursement of attorney’s fees, costs of court, and any other relief the court determines is just and appropriate.