Many long-term disability companies have a clause in their disability plans which change the definition of disability after 24 months. For the first 24 months of complete and total disability, a long-term disability insurance company pays the claimant if the claimant is unable to perform the material duties of his or her “own occupation.” Once the initial 24 months have elapsed under the “own occupation” standard, it’s not uncommon for long-term disability insurance companies to review and reevaluate cases in which they pay long-term disability benefits to find out whether or not the claimant meets the “any occupation” standard. Such is the case with Hellen Owens, a Business System Analyst at Fulton Paper Company.
Ms. Owens was no longer able to work with reasonable continuity due to the increasing pain she experienced as result of her rectal carcinoma (rectal cancer).
Ms. Owens’ situation is not unlike that of a number of people in America. Every year 150,000 Americans are diagnosed with colon cancer and more than 40,000 Americans are diagnosed with some form of cancer in the rectum. This disabling condition is becoming more common among Americans who consume a high-fat diet, smoke tobacco, or have a family history of colorectal cancer. Rectal cancer (or any kind of cancer) can cause such excruciating and debilitating physical and emotional pain due to the spread and growth of cancer cells throughout the body. The various forms of cancer treatment can leave a person physically, emotionally, and financially spent since a person is severely limited in how he or she is able to perform activities for daily living.
While it is not specifically stated in Ms. Owens’ civil complaint against Aetna, we can extrapolate from the complaint that the level of pain resulting from this disabling condition, and the treatment for it, escalated to the point to which it was necessary for Ms. Owens to stop working as of April 21, 2006.
Ms. Owens’ treating physician and pain specialist, Dr. Fugedy, supplied Aetna with documentation stating that Ms. Owens “was disabled due to various diseases causing pain.” Undoubtedly, Ms. Owens rectal cancer alone could cause pain enough to preclude her from performing the material duties of her own, and possibly any, occupation. Nevertheless, it also appears Ms. Owens’ treating physician insinuates there are other coexisting disabling conditions rendering Ms. Owens completely and totally disabled.
Consequently, Ms. Owens filed a long-term disability benefit claim under the long-term disability group plan her employer had with Aetna Life Insurance Company (Aetna). Aetna initially approved Ms. Owens’ claim and paid long-term disability benefit payments to Ms. Owens until April 21, 2008.
The following month, on May 14, 2008, Ms. Owens received a letter from Aetna stating that there was insufficient documentation to support Ms. Owens’ claim for further benefits to be paid to her. Therefore, Aetna terminated Ms. Owens long-term disability benefit payments. Ms. Owens appealed Aetna’s decision on May 26, 2008 and provided Aetna additional medical documentation that included the following:
- results of a neuropsychological evaluation demonstrating Ms. Owens inability to work with reasonable continuity because of cognitive and mental illness;
- additional statements from Ms. Owens’ pain specialist, Dr. Fugedy;
- statements from Ms. Owens’ internist, Dr. Amy Eubanks; and
- findings of the Social Security Administration.
Allegedly, according to Dr. Eubanks and her disability lawyer, Aetna requested Ms. Owens to pay Aetna back for the overpayment Aetna made to her that came as result of Social Security disability income not being taken into consideration by Aetna so they could offset her disability benefit payments.
Furthermore, as stated in the civil complaint filed by Ms. Owens and her Georgia disability attorney, Ms. Owens alleges that Aetna’s decision to terminate her long-term disability benefit payments rests on the opinion of a doctor who did not physically examine her and claimed “there were no cognitive limitations.”
The case is pending in United States District Court in the Northern District of Georgia in the Atlanta division. For her relief, Ms. Owens is asking the court for the following:
- long-term disability benefit payments she is due from Aetna;
- to hold Aetna responsible for breaching its fiduciary duties;
- to enjoin Aetna “from any further prohibited acts against [her]”;
- attorney’s fees and court costs that come as result of this litigation.