Attorneys Gregory Dell and Cesar Gavidia discuss problems encountered in litigation on behalf of a client who had a stroke. He returned to work, but three years later filed a claim for long-term disability benefits with Aetna Disability Insurance. Aetna agreed with his treating neuropsychologist that he could not work in his own occupation due to his symptoms indicating cognitive, visual, auditory, spatial, and perception issues and awarded him benefits.
After about 18 months on claim, Aetna terminated benefits based largely on its review of the claimant’s social media posts. His administrative appeal was denied when a neurologist, not a neuropsychologist, briefly examined him and determined he was no longer disabled.
Mr. Gavidia came into the case at that time and filed an ERISA lawsuit. In support of the litigation, a neuropsychologist examined the claimant and determined that there had been no cognitive improvement in the two years since Aetna had originally awarded him benefits.
Some issues in the court case are that: 1) According to a review of the disability policy, it appears that all that is ever required is for claimants to be unable to work in their own occupation, yet the denial letters indicated Aetna expected him to be unable to work in any occupation; 2) The independent medical exam (IME) for the administrative appeal should have been performed by a neuropsychologist, not a neurologist; and 3) The neurologist did not request any of the raw data used by the neuropsychologist in his testing before rendering his opinion.
There are many possible outcomes to litigation and Attorney Gavidia continues to represent his client on this matter. If you find yourself in a similar situation, contact Disability Insurance Attorneys Dell & Schaefer for a Free Consultation.