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A phlebotomist employed by Quest Diagnostics and diagnosed with RSD sues Aetna for denial of long term disability insurance benefits

In a case filed in the United States District Court of the Middle District of Pennsylvania, the claimant and her disability attorney accuse AETNA of abruptly and improperly terminating her disability benefit payments in violation of the Employee Retirement Income Security Act (ERISA) and 29 U.S.C. § 1132(a)(1).

While employed at Quest as a Phlebotomist, the plaintiff was ordered by her physician to take 6 to 8 weeks of time off from her job to recover after undergoing an osteotomy of her left fifth metatarsal, whereby “a bone is cut or shorten, lengthen, or change its alignment.” Unfortunately, during her recovery period, the plaintiff sustained further injury on June 28, 2004, when she was injured after falling from a motorized shopping cart when its seat became unbolted from its moorings causing her to fall to the floor.

Background of the disability Claim against Aetna Insurance Company

The plaintiff applied for her AETNA long term disability benefits and began receiving those on December 1, 2004. One month later, the plaintiff’s MRI showed fractures in the area of the original surgery that eventually caused her to have pain, swelling, and discoloration of her left foot. She had difficulty walking and had resorted to using crutches. After discovery of the fractures, the plaintiff was put on a regiment of injections in her left foot for pain relief, and by November 2005, the plaintiff physician noted that his client had developed generalized osteopenia and localised osteoporosis of her left foot.

Aetna ignores approval of social security disability benefits

The Comprehensive Pain Center declared the plaintiff disabled in its letter to AETNA and her employer on November 27, 2006 stating that she was “disabled secondary to chronic pain due to a diagnosis of Reflex Sympathetic Dystrophy (RSD) affecting the lower left extremity.” Upon completion of physical therapy, nerve blocks, and the placement of a spinal cord stimulator, the plaintiff still suffered from severe debilitating pain. Consequently, on November 14, 2007, the Social Security Administration (SSA) awarded her disability benefits retroactively from May 24, 2004.

In May of 2008, the plaintiff’s physician prepared an Attending Physicians Statement in support of her disabled condition noting she was unable to “crawl, climb, kneel or push” and “unable to lift more than 5 pounds.” One year later, he prepared another Attending Physicians Statement that verified that the plaintiff was suffering from seizures, cranial radiculopathy and left foot pain, and was unable to work. Then, on December 15, 2009, an Independent Neurological Evaluation was attempted on the plaintiff, but the doctor stated that the exam of her left foot was limited because it was too painful for the plaintiff to have the doctor exam her left foot completely. And, regardless of the pain, the evaluator determined that she was “capable of working an eight hour day, but had to avoid prolonged standing due to left foot pain, and that she could lift up to 20 pounds.”

The Plaintiff Has No Recourse except to Sue AETNA and Quest for Her Disability Benefits

With conflicting reports of the plaintiff’s condition, AETNA terminated her long term disability benefits effective August 23, 2010, stating that she lacked of sufficient medical evidence to support her disabled status. Armed with verifying medical documentation that she has ongoing left foot pain and was being treated for that pain with medication, the plaintiff appealed AETNA’s termination of her disability benefits. AETNA denied her appeal, stating that the plaintiff was capable of performing a sedentary job in which she was allowed to shift her position every 15 to 20 minutes.

After exhausting all her administrative appeals, the plaintiff engaged a disability lawyer to file her complaint, and the complaint was filed on June 8, 2011. In her complaint, the plaintiff and her disability lawyer allege that AETNA and the Quest Plan disregarded her disabled condition, discounted her medical evidence, terminated her disability benefits in an “arbitrary and capricious” manner, and violated ERISA. Consequently, she and her Pennsylvania disability attorney ask the District Court of Pennsylvania to award her:

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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.

Dell & Schaefer Client Reviews   *****

Ken A.

I’VE BEEN A CLIENT FOR 5 YEARS!

5.0 stars

A CLIENT FOR 5 YEARS!

Most likely… if you are reading this now… you are searching for ‘The Right Disability Attorney’! Realizing that no professional, including Greg Dell, can make everyone happy, the attorneys at Dell attempt to. They are still representing my best interests and have literally collected every dime I am entitled to under policy. Insurance companies know that Greg Dell’s firm is large enough to have assets sufficient to fight if necessary. They won’t ‘roll over’ because they don’t have the money to stay in the ring. Your insurance company, I assure you, know who ‘Greg Dell’ is. After they receive that 1st letter from Mr. Dell, putting them on notice that they are no longer to contact you, (that ALL correspondence goes through him)… I assure you their ‘method of operation’ changes gears. Please listen to me.

It has been my experience that once you call your insurance carrier and tell them you are even ‘thinking about’ filing a claim – their ‘helping hands’ attitude changes immediately. You are no longer an asset… you have now become a ‘liability’. Your insurance carrier knows that they will never make another dime from you. From now on you will only cost them money… perhaps for the rest of your life. It’s just business folks… we try to mitigate liabilities. If they can find a way to stall, question and deny… most likely they will.

Understand that insurance companies make money three ways:

1. Collecting premiums.

2. Investing revenues.

3. Denying claims.

They have already collected your premiums and will now determine if they can justify denying your claim… they simply will.

GREG DELL WILL NOT LET THEM GET AWAY WITH THIS CRAP!

If you are a professional and find yourself in the unfortunate position of filing a disability claim – I admonish you to not try this on your own!

HIRE A PROFESSIONAL!

Your decision is whether to hire a “disability claims consultant” or an “attorney” which specializes in professional disability claims. You’d be wise to decide upon the later. The reason being an attorney has “power” and “authority” and actually “represents you”. He/she has authority (power of attorney) to actually communicate with your insurance company and do “Whatever It Takes”. A disability claims consultant does exactly that… they “consult” with “you” (not the insurance company) and make recommendations… they tell you what to say and do.

Mr. Dell notified my insurance company that my claim was legitimate and justified and that they were simply going to pay my claim. 5 years later I have received every single payment, in full and on time!

If you have not decided yet… please listen to me. You are about to step on the field of battle with Goliath. You must never forget that these insurance people are good… very good. They know what they are doing. All day long claims adjusters look for ways to deny claims. They know all the tricks. Unless you are King David… you are going to need much more than a rock.

In conclusion consider this… right now you are not looking for a friend. You need someone who knows what they are doing… and does it exceptionally well. Do yourself a favor and call Greg… call him right now. I assure you… you’ll sleep much better tonight!

***** 5 stars based on 202 reviews

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