Office Depot employee files suit against employer and Aetna for unpaid disability benefits

An Office Depot employee and her Georgia disability attorney filed suit against her employer and Aetna Life Insurance for unpaid disability benefits on November 3, 2011 in the United States District Court for the Northern District of Georgia Atlanta Division.

Marian A’s Office Depot employee benefits included disability income in the event of a disabling condition precluding her from working. That event presented itself on January 30, 2009 when Marian could no longer perform her job duties as a manager due to surgeries to her feet and a herniated disc in her back.

With a monthly salary of $2,745.69, Marian was initially entitled to temporarily receive 50% of her weekly salary for twenty-four weeks. She received disability benefits for twenty weeks and then the insurer terminated those benefits. The denial came with an explanation that since Marian had not visited her treating physician for two months, she had no reason for no longer being away from her job, and thus her benefits would be discontinued. Having lost her eligibility for short term temporary disability before the full 24-week time period, Marian does not meet the requirements for long term disability benefits and would not normally be entitled to long term disability benefits per her Aetna plan.

Claimant Appeals Aetna’s Decision to Discontinue Disability Benefits

On August 6, 2009, Marian appealed the insurer’s denial stating that she was “unable to stand or walk for more than an hour without her foot swelling, she had pain radiating up in her leg and back, and her job required her to be on her feet eight to ten hours per day.” She also submitted paperwork from her treating physician attesting to this statement to no avail. Her doctor did indicate that Marian could possibly perform a sedentary position, but that any work requiring weight bearing would cause her extensive pain.

Aetna performed their own physician evaluation of Marian and its doctor said he could not find any “objective medical evidence to support [Marian’s] complaints.” Consequently on September 29, 2009, Aetna informed Marian that the denial decision was upheld to terminate her temporary income disability benefits. Marian proceeded to appeal the decision again and sought the opinions of an orthopedist and a neurologist, both agreeing that with Marian’s medical background, her primary problem was that of pain management and inability to function while standing. They recommended that Marian not work. After more tests and more reviews, Aetna again stood by its denial of Marian’s disability benefits, which led to the subject lawsuit.

Claimant’s Records Not Reviewed in Entirety by Aetna

After requesting a full copy of all Office Depot’s and Aetna’s records used to determine her ineligibility of disability benefits payments, Marian discovered that the insurer’s reviewers had incomplete records concerning her medical condition. Marian provided Aetna with the missing information, asked for a copy of her plan’s description, and appealed the decision again. At this point her appeals were exhausted and Marian was forced to hire a disability lawyer to go to battle for her.

Disability Attorney Petitions District Court to Weigh in on Client’s Denied Disability Benefits Claim

Filing a lawsuit in October, Marian and her lawyer alleged that Aetna’s decision to terminate her disability benefits was wrong, arbitrary and capricious, owing and subject to the penalty of $110.00 per day “for failure to provide the applicable requested documentation about her plan as she had requested earlier.” Consequently, Marian and her disability attorney petition the District Court to pass a judgment against the insurer and award her disability benefits, interest, attorney fees, expenses of litigation, court costs, penalties and nay further relief the Court “deems Just and proper.”

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. For a free consultation, please call 800-828-7583 or use our contact page.

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There are 8 comments

  • Added Stress,

    Under ERISA, Aetna has up to 45 days to render a decision once all of the documentation requested is provided. Therefore, if your policy is governed by ERISA it could take that long before you know.

    Stephen JessupJun 17, 2013  #8

  • Just like a previous post, I also am having some difficulty with Aetna approving my short term disability claim. First they claim its because they have not received medical records from my doctor’s office. However my doctor’s office had no record of any such documentation from Aetna. I followed up with both my primary care physician and psychiatrist and made sure to get them faxed over. Now that they have the medical records, they are saying they are under review. They have been under review for 2 weeks, what can be taking so long?! I get bad headaches, have depression, high blood pressure and anxiety. The going back and forth with Aetna for weeks now and it’s causing me even more stress. For me also, disability insurance is my only source of income since I am on medical leave.

    Added StressJun 16, 2013  #7

  • Ms. Smith,

    Aetna is notorious for denying disability claims by stating that there is a lack of medical evidence. This is probably Aetna’s number one reason for denying claims. Contact us privately and send us a copy of your denial letter. We will review it and let you know immediately if we assist you with the recovery of disability benefits.

    Gregory DellAug 22, 2012  #6

  • I am having the same issue with Aetna, they called and denied my benefits based on lack of medical evidence which my PCP sent my Orthopedic surgeon and my notes from physical therapy and note from counselor stating my medical condition evidence, which I have same issue that I was experiencing from last year that they approved. I suffer from Cervical stenosis in the C3-C4 C5-C6, I have chronic muscle spasms as a result and migraine headaches, I was currently diagnosed with bulging disk in my back which was causing issue for me to sit for prolong periods of time and osteoporosis.

    Johnna SmithAug 21, 2012  #5

  • My Aching Neck,

    If the accident was 25 years ago then it is likely that your condition would be considered an illness and not an injury.

    Gregory DellAug 16, 2012  #4

  • Is surgery for cervical stenosis caused by a 25-year-old injury (with symptoms for 20 years), considered as an “illness” or “injury” as far as Hartford is concerned for short-term disability? They pay on day 1 for an injury, but there is a 30-day waiting period for an illness. They define “illness” as “caused or contributed to by: any condition, illness, disease or disorder of the body”.

    My Aching NeckAug 15, 2012  #3

  • Nadege,

    You should personally get copies of the medical records and send them in yourself to Aetna.

    Gregory DellAug 8, 2012  #2

  • I am having some difficulty with Aetna paying my short term disability claim. They claim its because they have not received medical records from my doctor’s office. However my doctor’s office has no record of any such documentation from Aetna. I am being treated for migraines, depression, high blood pressure and anxiety. I’ve been going back in forth with Aetna for weeks now and because it’s adding to my stress my therapist suggested I limit my contact with Aetna. However the disability insurance is my only source of income since I am on medical leave.

    Nadege FrancoisAug 7, 2012  #1

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