• Aetna LTD Denial Reversed for Failure to Address Medication Side Effects

Does a disability insurance company need to consider the side effects of my medications?

Disability insurance companies are notorious for ignoring the cognitive side effects that most disability claimants experience from their medications. Disability companies are aware of the side effects of narcotics; yet they often fail to consider how working under the influence of these prescribed drugs limits a person’s ability to work. Disability benefit companies are required by law to consider the side effects of each and every medication taken by a claimant. Watch our video in which Attorneys Rachel Alters and Gregory Dell discuss an Aetna long term disability denial that was reversed due to Aetna’s failure to reasonable evaluate the pain medications taken by a woman with chronic back pain. Contact any of our disability insurance attorneys to discuss your claim.

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There are 8 comments

  • Wantto, I do not have any experience in dealing with Companion as it relates to SSDI overpayment negotiations. That being said, most carriers do not negotiate a lower re-payment amount but will typically negotiate a re-payment plan. The bigger concern would be maintaining the “physical” disability as opposed to mental health disability to maximize the benefit for as long as possible. Please feel free to contact our office to discuss your claim in greater detail.

    Stephen JessupOct 24, 2017  #8

  • I have the same problem regarding medications to treat severe lower back pain, nerve pain in my right leg, neuropathy, high blood pressure, depression, anxiety, and insomnia. My former employer’s group disability company is Companion Benefits. I went out on disability from a well-paying job in IT after having to take too many days off due to back and leg pain. That was in October 2015. I had to go 4-weeks without pay before STD kicked in. My conditions progressed downhill as time went on an no doctors could find any root causes to my problems.

    In the 5th month into my STD, I was sent forms to fill out qualifying my LTD. I had to do them on my own because my wife was busy caring for her dying mother. It took me a month to get them filled out because I could not stay focused and could not comprehend everything that I was signing. One of the forms was my agreement to pay them for any lump-sum back pay from social security that I might receive if approved, and one was acknowledging that my monthly benefit payments would be offset by my monthly SSDI payments. I should not have even been signing any legal forms or handling any financial transactions at that time because of my mental impairments from my medications. Once the forms were submitted, it took 3-months without pay before I was approved. During that time, I almost lost my house, had to stop paying on my credit cards, and eventually surrendered two cars. I could barely keep up prior because of the reduction of my income.

    In the 8th month of my LTD, I was required to apply for SSDI. My payments were cut in half until I could provide proof that I had sent the forms into social security. I was severely depressed then because both my wife’s mother and my mother died within a week of each other in June of 2016. It took me 3-months to gather all of the information that social security required. My wife had to help me with that because of all the information that was needed and I just couldn’t handle it all. My application was submitted in February 2017. In January of 2017, I received a letter from Companion stating that me definition for disability had been changed from physical to mental. That was their interpretation, not my doctor’s. Then in May of 2017, my claims rep from Companion called me to state that my LTD benefits were terminated effective immediately because my doctor neglected to keep his records updated for my on-going disability. I appealed, had my doctor update my records, and write a letter on my behalf stating the degree of my disability and the primary reason. It took them 90-days to come to the conclusion that I was in fact disabled and my benefits were reinstated in September 2017. My classification of disability was also changed back to physical.

    During the appeal process, in June of 2017, I was approved for SSDI and was paid a lump-sum amount of 32k for back pay and I received my first month’s SSDI payment. I have not told Companion that I was approved because I have decided not to pay them the lump-sum payment that I received from SSDI. It seems that Companion will do whatever they can do from getting out of paying you benefits that you are entitled to, so I don’t know when they just might pop up and cut me off again. A portion of the lump-sum pay that I received was used to live off of during the 90-days appeal process, another large portion was used to payoff my wife’s debts so that we could keep her good credit, and so that we could afford our house payment, her car payment, my private medical insurance (I don’t qualify for Medicare until April 2018), utility bills, living expenses, etc. if Companion was to cut me off again before my next review date in February 2018.

    I have consulted an attorney about filing chapter 7 bankruptcy. I would basically be a “no-asset” case based on my income, the type of my income, and the exemptions that I would qualify for under state law. I asked about having to have what I would have to pay back Companion discharged and he said that it was possible, but they might contest it.

    I am really unsure how I should proceed. I don’t know if I have a legal case regarding signing Companion documents while under a severely impaired state of mind due to my medications. I have also wondered if it might be possible to negotiate a lump-sum settlement that would eliminate the SSDI back pay and the difference that I have been overpaid the last two months because of the SSDI offset in my Companion payments. Can you tell me if you have had any clients that you have worked with that has Companion Benefits as their LTD carrier? If so, are they difficult to work with? Do you think it might be possible to represent me to negotiate a lump-sum settlement with them. For physical disability, my coverage goes until age 65 and I am currently 52 years old.

    Any advice would be greatly appreciated .

    Thank You!

    Wantto B. AnonymousOct 21, 2017  #7

  • Laura, did you file an appeal of the denial of your benefits? If not, and you are still within the 180 day deadline to file same please feel free to contact our office to discuss how we may be able to assist you.

    Stephen JessupFeb 13, 2017  #6

  • The video about medication side effects hits the nail on the head. Aetna denied my claim when I was taking 14 different medications a day to try to manage high blood pressure and diabetes. The medication side effects caused a 35 lb. weight loss in less than 2 months, insomnia, nausea, and other unpleasant issues.

    My doctor was furious when my claim was denied and said it was not unusual for someone newly diagnosed to experience problems until such time as the correct medication balance was achieved. He encouraged me to go to court. Unusual for a physician to take that stance.

    LauraFeb 8, 2017  #5

  • Anon, unfortunately, there would be nothing that we could do to force a doctor to keep records a certain way- so really, there is not much guidance that we could provide on that subject.

    Stephen JessupFeb 22, 2016  #4

  • Thanks for all you do to help us better manage our claims! Clearly we claimants need to get drug side effects noted in the medical record. I DO work toward this goal. BUT, what about MD’s choosing NOT to note side effects in writing because it avoids future liability toward them as the prescriber? I asked my MD – why are no side effects listed in my office visit notes and instead are statements like “patient managing ok on these high doses” ? My MD answered, “my partner well documented a patient’s drugs side effects and the patient later sued saying patient should never have been prescribed drugs that cause these problems.”. Otherwise, my MD clearly supports my disability claim in writing.

    AnonFeb 21, 2016  #3

  • Richard, thank you for sharing your experience and opinion.

    Stephen JessupFeb 19, 2016  #2

  • I have been there and done that. In my opinion taking narcotics or opioids for chronic back pain causes more harm than good. Take it from a 100%+ service-connected disabled veteran and NML insured.

    RichardFeb 18, 2016  #1

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