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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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

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