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Federal Court Agrees with Aetna’s Termination of Disability Benefits

In Hopper v. Aetna Life Insurance Company, a machinist with 11 separate medical diagnoses was initially granted short term disability benefits. When those benefits were exhausted, Aetna granted him 24 months of long term disability benefits when Aetna determined he was disabled from performing the duties of his own occupation. Due to his respiratory problems and skin rashes and visual problems, it was not difficult for Aetna to determine that he would never be able to return to work in the “dusty or dirty environment” of his own occupation of being a machinist. Also, due to his visual problems, it would not be safe for him to work as a machinist.

After 24 months of receiving long term disability benefits, the definition of “disabled” under the Aetna policy changed from being unable to work in a claimant’s own occupation, to “unable to work at any reasonable occupation” due to the disabling condition. As a result, Aetna terminated his benefits when it determined he could work in a clean office environment as an assignment clerk even though that position would require accommodations for his visual impairment problems. Hopper’s administrative appeal was denied and he filed the ERISA lawsuit.

Federal Court Upholds Aetna’s Termination of Benefits Even Though Employment Would Require Accommodations

At Aetna’s request, an ophthalmologist and a dermatologist reviewed Hopper’s medical records. A vocational rehabilitation counselor was consulted. All determined that Hopper’s visual acuity problems prevented him from working in an occupation that required “the ability to see small print or find detail without the use of a magnifying device.” Aetna then determined that Hopper could work as an assignment clerk even though he would have to use a magnifying device.

Hopper complained that Aetna should not be allowed to terminate his benefits when the job Aetna said he could perform would require “accommodations for his visual impairment.” The New Hampshire federal court disagreed and, relying on first circuit precedent, concluded, “it was permissible for a benefits committee to factor in a claimant’s ability to work with accommodations when determining that the claimant was ‘no longer unable to perform any job for which [he was] qualified by education, training or experience.'”

Claimant Also Failed to Meet His Burden of Proof

Hopper claimed his medical record was “replete with medical opinions that he is disabled from any work.” The court found the problem with that claim is that Hopper did not include any citations to the administrative record to support that claim and the court found none of the favorable opinions he mentioned in the Joint Statement of Material Facts filed in support of the ERISA lawsuit. The burden is on the claimant to prove he is disabled. In this case, since he failed to provide records to support his claim, he failed to carry his burden and Aetna was reasonable in finding he was not disabled under the “any reasonable occupation” clause of the benefits policy.

This case was not handled by our office, but it may provide claimants guidance in their pursuit of long term disability benefits when the definition of disabled changes from “unable to work in claimant’s own occupation” to “unable to work at any reasonable occupation.” If you need assistance with a similar matter please contact any of our lawyers for a free consultation.

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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.

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