Product Analyst, Nancy W., 49, and her Arizona disability attorney filed a complaint in the United States District Court for the District of Arizona on October 26, 2011 against her employer Intel Corporation, Aetna Life Insurance Company and Reed Group (the administrator of Intel’s Aetna Plan) to force them to provide her with her entitled disability benefits per the terms and conditions of her employee disability insurance policy.

Citing ERISA (the Employee Retirement Insurance Security Act of 1974) violations and 29 U.S.C. § 1132(a)(1)(B) provision violations that the Defendants engaged in regarding Nancy W.’s disability claim, Nancy W.’s attorney petitioned the District Court to provide Nancy W. with:

  • A judgment in her favor against the Defendants;
  • Reinstatement of Nancy W.’s short term disability benefits and her long term disability benefits;
  • Prejudgment interest on any benefits accrued prior to the date of judgment;
  • Payment of Nancy W.’s disability benefits per the terms and conditions of her plan;
  • Attorneys’ fees; and
  • Any other relief she may be entitled to.

Arizona Claimant Denied Aetna Short Term Disability Benefits in 2007

Nancy W. became disabled in 2007 and applied for her short term disability benefits through her employee disability benefits plan. Nancy W. was denied continuing short term disability benefits in November 20, 2007 at which time she appealed the termination of those benefits and after exhausting all administrative appeals, filed a Complaint on May 20, 2010. Eventually, Nancy W. and her disability attorney voluntarily dismissed the complaint after the plan administrator Reed Group agreed to conduct supplemental review of Nancy W.’s claim. Reed Group upheld the earlier decision, Nancy W.’s disability benefits remain terminated, and Nancy W. filed suit again in the United States District Court of Arizona.

Background of Aetna Claimant’s Disabling Condition

The first termination of Nancy W.’s benefits occurred when two physicians indicated that Nancy W.’s previous blood pressure condition had stabilized and stated that her medical records "failed to show that the severity of her symptoms precluded her from performing job duties." Providing the insurer with contradicting medical records, Nancy W. challenged the two doctors’ opinions to no avail. So, Nancy W. applied for her long term disability benefits. Unfortunately, since her short term disability benefits had been terminated and Nancy W. had only used 183 days of her 364 days of short term disability benefits, she was disqualified from being eligible for long term disability benefits.

Lawyer Backs up Client’s Claim with Ample Case Law

Citing case law to back up Nancy W.’s claim, Nancy W.’s lawyer asks the District Court to consider that Aetna might have a conflict of interest in that the insurer not only provides the claimant’s employee insurance plan but is involved in the administrative decisions determining if a claimant has a legitimate claim as well. The pair allege that Aetna deliberating or negligently refused to comply with it obligation to inform claimants of why a claim decision was made denying benefits. They accuse Reed Group as an affiliate of Aetna of being negligent as well.

In the suit, Nancy W. and her disability lawyer ask the District Court to:

  • Enter a judgment in favor of Nancy W.;
  • Reinstate Nancy W.’s short term disability benefits and long term disability benefits retroactively to November 21, 2007;
  • Order Aetna to pay prejudgment interest on all owed benefit amounts accrued prior to the date of judgment;
  • Order the insurer to continue paying Nancy W. disability benefits per the plan;
  • Award Nancy W. attorneys’ fees; and
  • Provide Nancy W. with other relief she might be entitled to pursuant to Arizona law.

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.