Finding itself named as the defendant in multiple lawsuits throughout the United States this summer, Aetna Life Insurance has a lot of denied and terminated long term disability benefit claims to answer for in District Courts.
Case 1: Aetna Life Lawsuit in Georgia
Donald W. and his Georgia disability attorney filed a lawsuit in the United State District Court Southern District of Georgia Augusta Division on August 8, 20011 under ERISA (Employee Retirement Income Security Act of 1974) in an effort to recover Donald W.'s disability benefits he is entitled to pursuant to his ADP Total Source, Inc. disability plan. An employee of ADP Total Source, Inc., Donald W. purchased long term disability group insurance from his employer that was underwritten by Aetna. The plan stipulated that Donald W. would be paid his disability benefits after twenty-four (24) months of his qualification of such benefits provided: "(1) he was unable to perform the material duties of his own occupation solely because of disease or injury; and, (2) that his work earnings were 80% or less of his adjusted pre-disability earnings."
As the result of a pre-existing back condition, Donald W., a heavy duty diesel mechanic, was unable to work at any reasonable occupation and was declared disabled on February 1, 2010. Upon submission of his disability claim, Donald W. was denied; and after filing all his administrative appeals, Donald W. continues to be denied his disability benefits by Aetna. Consequently, Donald W. and his Georgia disability attorney filed a lawsuit against the insurer to try to convince the Court that Aetna's denial of Donald W. ‘s disability benefits is contrary to the terms of the policy, that that decision is erroneous, capricious and unreasonable, and he and his Georgia disability lawyer asked the Court to order Aetna to fulfill its obligation to pay Donald W. his disability benefits as well as reimburse him for reasonable attorney's fees, Court costs and interest on his denied benefits.
Case 2: Aetna Lawsuit in Kentucky
Priscilla J. and her Kentucky disability attorney filed a lawsuit against Aetna in the United States District Court of the Western District of Kentucky at Bowling Green on July 13, 2011 in an effort to recover Priscilla J.'s disability benefits due to be paid to her "under the terms of her employee benefit plan." An employee at Sensus Metering Systems, Priscilla J. was notified by Aetna in a letter dated April 2, 2009 that her appeal of the termination of her short term disability benefits would be terminated because the insurer determined Johnson's "medical information did not support functional impairment that would prevent her from performing the essential duties of [her] own occupation." Priscilla J.'s disability benefits were initially approved on July 12, 2008 and continued through November 27, 2008.
Priscilla J.'s disability lawyer alleges that the reason Aetna denied Priscilla J.'s disability benefits was due to the insurer's failure to be contacted by Priscilla J.'s treating physician as her treating physician was out of town and unaware that his input was needed. Upon returning from his out-of-town absence, Priscilla J.'s treating physician tried to contact Aetna's reviewer to verify Priscilla J.'s disability, but was ignored by the insurer. Consequently, since Priscilla J.'s short term disability benefits were terminated, she had no way of procuring her long term disability benefits and petitions the District Court to order the insurer to conduct a "full and fair review" of her disability claim in its entirety.
Stating that the denial of her claim was "unreasonable, arbitrary and capricious" and has resulted in "great hardship to [Priscilla J.] and her family," Priscilla J. and her disability attorney ask the Court to reverse Aetna's denial of Priscilla J.'s claim, reinstate her benefits, reinstate her ability to apply for long term disability benefits, reimburse her for attorney's fees, and provide any other appropriate relief.
Case 3: Aetna Lawsuit in Minnesota
On July 15, 2011, a Hubbell, Inc. warehouse associate and his Minnesota disability lawyer filed a lawsuit against Aetna Life Insurance Company in the United States District Court of Minnesota under 29 U.S.C. § 1132(e)(2) and ERISA § 502(e)(2) to recover Charles B.'s long term disability benefits under his employee disability plan. Employed by Hubbell Inc., Charles B. had to stop working in May of 2008 as a result of his disability. Disabled on May 30, 2008, Charles B. applied for and was approved and paid long term disability benefits from November 30, 2008 until December 22, 2008. His disability benefits were terminated by a letter from Aetna with the insurer alleging that Charles B.'s disability "was a result of an exacerbation of a pre-existing condition." After several appeals, Charles B. eventually exhausted all his administrative remedies available per Aetna's procedures and hired a disability attorney to help him bring his case to the Minnesota District Court for a decision.
In their complaint Charles B. and his lawyer request the District Court to enter a judgment against Aetna to compel the insurer to pay Charles B. retroactive disability benefits from May 30, 2008, declare Charles B. entitled to ongoing disability benefits under his Aetna plan, accrued interest, court costs, disbursements and other litigation expenses, and any "further relief as the Court may deem just and proper."
Case 4: Aetna Lawsuit in New Jersey
A complaint against Aetna Life Insurance Company was filed on August 8, 2011 by Jennifer M. and her New Jersey disability lawyer in the United District Court of New Jersey to collect all past due long term disability benefits and all out-of-pocket medical expenses incurred by Jennifer M. as a result of Aetna's wrongful denial of her Aetna disability benefits. In possession of a valid Aetna disability insurance policy, Jennifer M. began receiving disability benefits from Aetna on June 1, 2008. But, on July 16, 2009, Aetna denied Jennifer M.'s long term disability claim contending that her condition was a pre-existing one and thus disqualified her in receiving disability benefits ongoing.
Disabled and unable to engage in gainful employment in any capacity, Jennifer M. exhausted all her administrative appeals with Aetna and had to file this lawsuit to reclaim her disability benefits. Jennifer M. was employed by Camuto VCS Group at the time of her disabling event. And, since Aetna has refused to provide Jennifer M. with her disability benefits as set forth in her employee disability insurance policy, Jennifer M. and her disability lawyer allege that she has sustained damages as a direct and proximate result of Aetna's denial of her disability benefits.
In the lawsuit Jennifer M. and her lawyer demand judgment against Aetna and request:
- A declaration that Jennifer M. is entitled to long term disability benefits pursuant to the Aetna plan;
- Interest and suit cost; and
- Reasonable counsel fees.
About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.