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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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FAQ

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   *****

Megan B. (Virginia)

My experience has been a delight. I filled out the consultation form and was contacted immediately. Cesar and Michal were not only professional, but personable. They kept me informed throughout the process, and was available to address any questions or concerns I had. This team worked together and got my benefits re-approved in a short period of time. They have handled everything effortlessly and efficient.

Might I add during the time I first started working with them a hurricane hit where their office was located. They never skipped a beat and did not push me aside. They continued to stay in contact and work my case, now that’s commitment! Even after my benefits were re-approved, they continue to provide excellent service and are there for me whenever I need.

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