Richard R. and his Illinois disability attorney filed a lawsuit in the United District Court in the Northern District of Illinois, Eastern Division on December 9, 2010 against his employer and AETNA Life Insurance Company for long term disability benefits. A Weston Engineering Inc. employee since July 6, 2009, Richard R., a headache sufferer since he was a teenager, complained to his family doctor of intensification of his headache problems. Consequently, Richard R.’s doctor increased Richard R.’s pain medication to try to remedy the situation.
AETNA Claimant is Diagnosed with a Cancerous Tumor
Shortly after his hiring and his doctor’s appointment to address Richard R.’s worsening headaches, Richard R. underwent an MRI Open Brain Without and With Contrast test. This MRI showed an abnormality of Richard R.’s brain and as a result he underwent a biopsy surgery on August 28, 2009 which determined that Richard R. had a benign tumor. Then, on March 31, 2010, a follow-up MRI was done on Richard R., and since the tumor had changed, another biopsy was performed. On April 8, 2010, Richard R. was diagnosed with a cancerous tumor – a left hemisphere Gliobalstoma – for the first time.
Undergoing aggressive treatment that was severely debilitating and disabling, Richard R. applied for and received short term disability benefits from his employee AETNA insurance plan. After receiving his 13 weeks of short term disability benefits, Richard R.’s disability payments were exhausted, Richard R. applied for long term disability benefits, but was denied those benefits as the insurer determined that Richard R.’s Gliobalstoma tumor was a pre-existing condition. As such, according to AETNA, Richard R. did not qualify for long term disability benefits.
Not qualifying as a pre-existing condition as Richard R. had not been treated or diagnosed for the Gliobalstoma during the time period that would qualify it as a pre-existing condition, Richard R. used AETNA’s administrative appeal process to have his claim re-evaluated. AETNA continued to deny Richard R.’s appeals until he ran out of appeals and was forced to file this lawsuit.
Claimant and His Attorney Petition the Court for Relief
In the lawsuit, Richard R. and his disability lawyer contend that Richard R. does qualify for his ERISA-controlled disability benefits and request that the Circuit Court enter judgment in Richard R.’s favor against AETNA , provide him with the disability benefits he is entitled to, pay him pre-judgment interest, order AETNA to continue paying Richard R. benefits as long as he continues to meet the terms and conditions of his AETNA policy, award him attorney’s fees, and recover all other relief available to him in addition to the cost of the suit he had to file to receive his entitled disability benefits.