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.

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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.

Reviews   *****

BK. K.

After my claim was denied I was at a standstill. Not knowing what to do next, I happened upon Dell & Schaefer on an Internet search… skeptically I investigated and did due diligence. After initial contact, I firmly realized it was in my best interest to have Dell & Schaefer represent me. Throughout the appeal process, my emails were answered, my phone calls were returned and there was no such thing as a stupid question. It was a complicated case and my confidence was positive throughout the appeal experience. After several months I was put back on claim and there is no question I could not have done this without Dell & Schaefer’s excellent and fair representation.

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