Dell & Schaefer ERISA Administrative Appeal Successful: Claimant suffering from Sleep Disorders, Depression and Fibromyalgia Now Receiving Long Term Disability Benefits

Attorney Alexander Palamara of Dell & Schaefer is happy to report of another client’s approval for Long Term Disability (LTD) benefits by Aetna. Our client previously worked as a Nurse for the Lee Memorial Health System in Florida since 2001. Unfortunately for our client, she began to suffer from the following medical conditions: Narcolepsy with Cataplexy; Severe Obstructive Sleep Apnea; Insomnia; Hypersomnia; Sleep Paralysis; Chronic Fatigue; Dizziness, Major Depression, Recurrent Episode, Severe; Post Traumatic Stress Disorder; Bipolar Disorder; Morbid Obesity, in partial remission; Peri-Menopause; and Fibromyalgia. These conditions left her unable to perform the material duties of her own occupation.

Fortunately for our client, working for Lee Memorial Health System provided her with Long Term Disability Insurance Coverage for such a situation. Our client was forced to leave work in early April 2014 and filed a claim for LTD benefits by herself shortly thereafter.

Claim Initially Denied

Unfortunately for our client, Aetna Life Insurance Company, the Long Term Disability Claim Administrator and Payer of Benefits, denied her claim by way of a denial letter dated July 18, 2014. In its denial letter, Aetna ultimately concluded that our client was not disabled as defined by the policy as of July 17, 2014, the date benefits should of begun. Aetna stated that the clinical information it had on file was “insufficient to support the presence of a functional impairment from a physical or mental perspective… and therefore we find that you do not meet the definition of disability…”. In support of its contention, Aetna relied upon a clinical review by one of its employees and a “medical peer review.” Within a few days of receiving the denial letter from Aetna, the claimant found us and quickly became a client of Dell & Schaefer.

Administrative Appeal filed by Dell & Schaefer

After reviewing the Administrative Record provided by Aetna, as well as the medical records of the client, it was apparent to us that Aetna’s decision was blatantly incorrect, as well as arbitrary & capricious. Furthermore, the “reviews” that Aetna relied upon were not found in the complete administrative record provided to us. Needless to say, those reviews were misguided at best.

Our client’s medical records and the support of her treating physicians were overwhelming. Furthermore, prior to the time that we filed an administrative appeal, our client was approved for Social Security Disability Benefits. Armed with the above, an administrative appeal was timely filed which challenged Aetna’s denial of her claim.

Within 5 weeks of the filing of the administrative appeal, Aetna sent a letter stating that our client’s claim had been re-opened for benefit payments. Thus Aetna has agreed with our contention that our client is unable to perform the material duties of her own occupation. The back benefits owed to her will be paid shortly and our client will be receiving a monthly benefit for the time being and hopefully the long future.

Though our client is back on claim, she knows the fight does not end. After 24 months of benefits, it typically becomes more difficult to stay approved under most LTD Group ERISA policies. This is due to the change in definition of disability. At that point, the client will have to prove that she is “unable to work at any reasonable occupation.” Though the change in definition of disability is not close to occurring, the attorneys at Dell & Schaefer will continue to fight to ensure that Aetna does not deny her claim now or in the future.

If you have been denied Long Term Disability Benefits by Aetna or any other insurance provider, please do not hesitate to contact the Attorneys at Dell & Schafer for a free consultation.

Questions About Hiring Us

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.

Dell & Schaefer Client Reviews   *****

John S.

Integrity and honesty is an important attribute to me. My Dell & Schaefer (D&S) attorneys meet and share these attributes. D&S have an entire staff dedicated to serving their clients. They’re all very approachable and friendly while keeping the client’s best interests at the forefront. You can contact or call them at the drop of a hat and they’ll assist you. You’re not treated like a number; you’re a respected individual and friend. They care. That’s how they make me feel. They often ask how I’m doing; how I’m feeling (I’m in a lot of pain). Most of all, under their protective umbrella, you don’t have to deal with the insurance company. D&S does all that. They keep things straight. It’s comforting. I would not hesitate to recommend them first and foremost for any disability legal needs.

I’m a retired Army Soldier. I’ve been disabled for about four and a half years. I was working for a company (post-military retirement) when I became disabled after an unsuccessful service connected C-spinal surgery that caused me serious complications. My disability is permanent. I had disability insurance with the company that I worked for as an added benefit. After I went down, and once I met the 6 month period for long term disability, the Hartford insurance company began paying monthly disability payments; however, they were always requesting additional information. It was always repetitive information, non-stop, i.e., asking for the same information I had provided only a few months prior.

They wanted repetitive doctors’ statements. I saw many doctors in my state in an attempt to fix or reverse what was damaged during my surgery in an attempt to return to work. My doctors all said the same thing. My medical condition was permanent. They all said I would not improve or get any better through more surgery or physical therapy. In fact, it might have gotten worse if I tried more surgery. There was nothing the neurosurgeons could do for me other than pain management, and continued PT for pain management to improve my quality of life. My disability insurance company continued to hound me for additional information despite what the doctors had already provided to them. It was ridiculous and it was obvious that the insurance company was trying to find anything to negate the policy.

About 18 months ago the Hartford insurance company requested an “in-home” interview with me. Despite the fact that my medical documentation was excellent and well documented regarding my disability, I had grown tired of dealing with this company on my own. It had become stressful to the point that my health was suffering even more. I had no idea how to handle this powerful company at the pending interview and I felt I needed legal representation to get them off my back protect my rights during the interview. That’s when I decided to enlist the help of Gregory Dell. I found him on the internet, watched several of his You-tube videos, and I was convinced that he was the legal representation I needed to guide me and protect me from this insurance company and my right to disability benefits.

From the moment I contacted Gregory Dell and his attorney associate Alex Palamara, the lead attorney who handles my case, I was treated with respect and dignity. With little notice, both of these attorney’s guided me through a successful interview with the insurance company. They were present (via telecom) during the entire interview, which took about two hours. They had told me to be myself and to be totally honest with the investigator during the interview. That I was, but when I was offering too much information to the investigator, they would tell me when to stop. They’re experts in disability legal matters. I’m not and I listened carefully to their advice and direction. I’m glad I did.

***** 5 stars based on 202 reviews

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