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Truck driver denied disability benefits for chronic fatigue syndrome by Aetna

On July 26, 2002, Lee Williams, a truck driver for SYSCO since late 1994, became sick and was diagnosed later that year with chronic fatigue syndrome (CFS). As a truck driver, Mr. Williams was required to:

After applying for disability benefits in February 2003, Aetna denied Mr. Williams’ claim for long-term disability benefits on May 12, 2003, after obtaining a physical demand analysis that outlined Mr. Williams’ job duties and an Attending Physician Statement (APS) completed by the specialist who diagnosed Mr. Williams with CFS. Aetna also had a physician review Mr. Williams’ application and the rest of his file to determine Mr. Williams’ restrictions and limitations. This physician reviewer believed that the information provided did not indicate enough impairment to justify disability benefits.

In denying disability benefits, Aetna claimed that Mr. Williams had not shown how his subjective symptoms prevented him from performing his job. The policy defined disabled as being unable to perform the material duties of the employee’s occupation and having earnings of less than 80% of pre-disability earnings.

Mr. Williams appealed this denial on September 10, 2003, by having his treating physician submit a functional capacity questionnaire completed on August 11, 2003, which stated that although Mr. Williams had improved, he was still unable to return to work. Aetna denied this appeal on January 9, 2004, for lack of sufficient evidence to show Mr. Williams could not do his job as a truck driver.

On July 28, 2004, Mr. Williams informed Aetna that he had been awarded Social Security Disability Insurance (SSDI). Mr. Williams then filed suit. The disability benefits plan continued to argue that the evidence submitted by Mr. Williams was insufficient to show Mr. Williams could not do his job. Specifically, the functional capacity questionnaire was not fully completed by the doctor, so it appeared that a full functional capacity evaluation had not been done. Despite the physician’s statement that Mr. Williams was severely limited by fatigue, the doctor did not detail how Mr. Williams was limited from performing his job. As a result, the court held that the plan had not acted improperly in denying Mr. Williams his disability benefits.

See Williams v. Aetna Life Ins. Co., No. 06-3824, 2007 U.S. App. LEXIS 25515 (7th Cir. Nov. 1, 2007).

Questions About Hiring Us

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.

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It was a great experience I had with the whole team. Whoever I worked with through out the whole process was very responsive, detail and time sensitive. The cost arrangement was discussed up front so I knew exactly what my cost would be. My case was discussed in person, all the documentation I had available, I provided. Some specific statements were requested of me, friends and family. It was reviewed by Dell & Schaefer and it was determined that I had a strong case.

The appeal was submitted before the deadline and I had a copy of it to review. I was very pleased of the whole content of the submission. I read all the strong points of the appeal and I knew at that point that it was a very strong appeal case and one way or another Dell & Schaefer would win the case. It was a matter of principal for me and I feel that I got my point across to my employer. I could’ve waited to go through a trial but I did not because I really did not want to have this issue hanging over me any longer so agreed to settle my case.

They are very detailed, responsive, up-front, they tell you if you have a strong case, tell you the angle that they’ll use to go after your case, get all the appropriate documentation so as to back-up everything they say, they are time sensitive and keep you updated as time goes by. They are a great team! I had my concerns at first because they are not local but they gave me all the time I needed to have any discussions and ask any questions.

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