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:
- A designation of “disabled” as defined in her Quest disability plan;
- An order forcing AETNA and Quest to state that she is entitled to long term disability benefits
- Retroactive reinstatement of all overdue long term disability benefits under the terms and conditions of the Quest insurance plan;
- Interest and any and all overdue benefits under her policy;
- Reasonable attorney’s fees
- Any other relief the District Court deems necessary and appropriate under the circumstances of the case.