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.