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Massachusetts Disability Attorney filed lawsuit against the Aetna Life Insurance Company on behalf of Biogen Idec, Inc’s IT Technical Ops Lead for denial long term disability benefits

In the disability lawsuit of Joseph Mcdonough Vs Aetna Life Insurance Company, HM Life Insurance Company, Biogen Idec, Inc. & Biogen Idec., Inc., Group Long Term Disability Plan filed at the District Court for the District of Massachusetts, the plaintiff filed a federal lawsuit against Aetna for violations of the Employment Retirement Income Security Act (ERISA.)

Aetna Denies Long Term Disability Benefits

The plaintiff Joseph Mcdonough was a IT Technical Ops Lead/Technical Project Lead for Biogen, Idec, Inc. By virtue of his employment, the plaintiff was covered under a contract of insurance between Biogen, Aetna and HM Life Insurance Company. Both Aetna and HM Life Insurance Company were the insurer of the plan. In addition, Aetna also acted as the Plan administrator. The contract of insurance provided for long term disability benefits in the event the plaintiff was disabled within the definition of the plan.

Under the Plan, the definition of Disability is:

You will be deemed to be disabled on any day if:

  • You are not able to perform the material duties of your own occupation solely because of disease or injury; and
  • your work earnings are 80% or less of your adjusted pre-disability earnings.

If your own occupation requires a professional or occupational license or certification of any kind, you will not be deemed to be disabled solely because of the loss of that license or certification.

The plaintiff suffered symptoms brought about by a stroke on November 28th 2008 which included right sided numbness and weakness, loss of balance, Left Hip Bursitis and pain, Type I Diabetes, Hypertension, and Panic Attacks with PTSD.

Disability Application Filed with Aetna

As a result of the stroke, the plaintiff made a claim to Aetna for both short term and long term disability benefits for the period of time beginning on November 23rd 2008, when the plaintiff suffered from right sided weakness and numbness, was hospitalized, and diagnosed as having suffered a stroke through the present.

The plaintiff was approved for short term disability benefits for six (6) months by Aetna. Upon expiry of the short term disability benefits, Aetna approved the plaintiff’s claim for long term disability benefits on May 23rd 2009. On August 2009, Aetna began reviewing the plaintiff’s claim for continued benefits. Although the plaintiff’s attending physicians opine that the plaintiff is disabled and should remain out of work until October 9th 2010, Aetna terminated the plaintiff’s benefits on October 29th 2009 without properly assessing whether the earning capacity of the plaintiff was 80% of his pre-disability income and without providing any of the notice requirements required by ERISA to inform the plaintiff of his rights.

The plaintiff appealed to Aetna on April 21st 2010 the decision to terminate his claim for long term disability benefits and was granted an extension by Aetna until Jul 26th 2010 to submit additional information to support his ERISA appeal.

Aetna, however, sent the plaintiff a revised copy of its termination letter which contained the required ERISA’s notice requirements of the plaintiff’s rights. Although the plaintiff’s was granted additional time to submit additional information to support his appeal, Aetna started reviewing the plaintiff’s appeal on May 12th 2010 and determined that the “medical information did not support disability from own occ, 11/01/09”.

Aetna Applies Wrong Defintion Of Disability

In addition, on September 10th 2010, Aetna’s occupational medicine doctor, performed a review of some of the medical information submitted with the plaintiff’s appeal but reviewed them against the Social Security Administration criteria for determining disability. Aetna’s plan definition of disability required that the plaintiff be determined disabled in his own occupation while the Social Security Administration requires an individual to prove an inability to perform the duties of any occupation in order to receive benefits.
On November 17th 2010, after selective reviews and without any reference to the evidence submitted by the plaintiff, Aetna upheld its decision to terminate the plaintiff’s long term disability benefits.

Disability Insurance Lawyer Sues Aetna

In the lawsuit, the plaintiff alleged that Aetna:

As a result of Aetna’s actions, the plaintiff alleged that he suffered damages and is seeking relief through the Court for:

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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.

Dell & Schaefer Client Reviews   *****

Anthony M.

My experience with Mr. Dell and all of the staff working at the practice has been an excellent experience. Planning to make a claim for disability with a private insurance company can be very intimidating for the average person. Mr. Dell is professional and sharp, just what I was looking for in an attorney to represent my case. He walked me through every step and helped me make the best application for benefits. There were absolutely no surprises while applying for my benefits as we were both well prepared for any questions that could arise during the process. Mr. Dell was able to work with me and my physicians to make sure the application was thorough and complete. No mistakes were made along the way and my benefits were approved without any problems whatsoever. I will truly be grateful for Mr. Dell for the rest of my life.

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