Aetna Life Insurance Company (Aetna) was recently sued in three cases in the Federal Courts of Oregon, Tennessee, and Missouri by three separate Plaintiffs due to the wrongful denial of long-term disability benefits as covered by the Employee Retirement Income Security Act (ERISA). All three cases claim that Aetna wrongfully denied the rightful long-term disability benefits to the Plaintiffs as defined by the terms of their respective Plans.

The Oregon Case

In Troy R. Vs Aetna Life Insurance Company, Plaintiff was employed as a residential appraiser by Bank of America for the past 20 years. Plaintiff was enrolled in a group long-term disability Plan that was issued by Aetna, who also is the claims administrator of the Plan.

On or about May 6, 2009, Plaintiff became disabled as defined by the terms of the Plan and submitted a timely claim for benefits. Aetna began paying short-term disability benefits on May 6, 2009 and continued doing so until November 3, 2009. Plaintiff provided all information requested by Aetna throughout the process, leading to the initial claim for short-term disability (STD) benefits.

Plaintiff submitted a claim for long-term disability (LTD) benefits, but on November 4, 2009, Aetna denied this claim despite the fact that Aetna had not received any new information about the Plaintiff’s condition from the time the last STD extension was granted on October 20, 2009 to the date that LTD benefits were denied on November 4, 2009.

Plaintiff appealed the denial, adding more reports and medical information to support his claim that the denial should be overturned. However, on November 23, 2010, Aetna made a final administrative denial of the Plaintiff’s appeal and claim for benefits based on "a lack of medical evidence" regarding his condition and his inability to work. Due to exhausting all administrative appeals, Plaintiff has filed this lawsuit against Aetna.

The Tennessee Case

In Eileen S. Vs Aetna Life Insurance Company and Gannet Company, Inc. (Gannet), Plaintiff was employed as a copy editor for the Tennessan, a newspaper based in Nashville, Tennessee and owned by Gannet Company, Inc. Plaintiff was covered under an Income Protection Plan that provide a sick pay program, a short-term disability program, and a long-term disability program. Gannet maintained this program for its employees, while Aetna was the claims administrator.

Due to a disability, Plaintiff ceased working on July 12, 2008. Plaintiff filed a timely claim for STD benefits, which should have been paid between July 19, 2008 and January 10, 2009. Plaintiff’s claim for STD benefits were approved, but only paid through October 30, 2008.

Aetna sent a letter to Plaintiff dated November 12, 008 that terminated her STD benefits due to a lack of documented evidence of her medical conditions. Plaintiff appealed this denial and sent substantial amounts of additional evidence to prove her claim. She also submitted a claim for disability benefits to the Social Security Administration (SSA) as required under the terms of the Income Protection Plan, which was granted a Fully Favorable Decision on April 20, 2010.

Despite this, Aetna issued a final denial of STD and LTD benefits via a December 8, 2010 letter to the Plaintiff. Plaintiff has exhausted all administrative remedies, leading to the filing of this lawsuit against Aetna.

The Missouri Case

In Sandra A. Vs Aetna Life Insurance Company, Plaintiff was employed by Verizon Wireless (Verizon) and was covered by the disability insurance company as provided by Verizon, which was fully insured by Aetna.

Due to her medical conditions, Plaintiff has been totally disabled as defined by the terms of the Plan since November 1, 2009. Plaintiff submitted a claim for benefits, but was denied by Aetna. Plaintiff has exhausted all administrative appeals and has filed this lawsuit against Aetna.

Plaintiffs Seek The Following Relief

In all of the aforementioned cases, Plaintiffs seek the following relief from Aetna:

  • Full entitled benefits as defined by the terms of the Plaintiffs’ respective Plans.
  • All reasonable attorneys’ fees.
  • All related court costs.
  • All other fair and just relief as decided upon by this Court.

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.