Weston Engineering employee sues AETNA Life Insurance Company for denied disability benefits

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.

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There are 2 comments

  • Ann,

    Depending on the language used in the policy to define pre-existing condition there may be very little that can be done. Please feel free to contact our office to discuss your case further to see if there is something we can do to assist you.

    Stephen JessupNov 30, 2013  #2

  • After being out of work for 2 years, I was hired by a new employer and after 6 weeks on the job I had a colonoscopy that my Dr. had recommended for my internal hemorrhoids and it was found that I also had rectal cancer, a tumor.

    I began treatment immediately and was taken out of work on short term disability, after 6 months that expired and my file was sent to the Standard Ins company for Long term benefits to begin, I just received my denial based on pre existing condition, stating that because I had been seen the month before by my dr. who referred me for the colonoscopy they beleive that even though I was not diagnosed or even mis diagnosed that the cancer was still there and that makes it preexisting.

    I really need help with this, I was being treated for hemorrhoids! I had no idea nor did my dr. that it was anything more than that.

    Please let me know if anyone has had this issue with this or any other ins. company and how the appeal was handled, I am now living with my daughter who had to relocate to my state and get a new job and an apartment to take care of my financial and medcial needs.

    AnnNov 29, 2013  #1

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