Disability Blog & Cases:
Aetna Is Sued For Failure To Pay ERISA Benefits To Boeing Employee For Injuries Sustained In A Shooting

A Washington disability lawyer filed a federal lawsuit in the District Court for the Western District of Washington, at Seattle, against Aetna Life Insurance Company (Aetna) and The Boeing Company Long Term Disability Plan (Boeing). The Plaintiff, Patrick D., worked as a real-time software engineer for Boeing, which contracted with Aetna to provide long-term disability coverage to its employees. The Plaintiff’s employment with Boeing afforded him the protections under this Plan.


Disability Blog & Cases:
Unum Sued By An Ophthalmologist And A BJC Healthcare Employee Who Both Were Denied Disability Benefits

Unum Life Insurance Company Of America (Unum) was sued in two different lawsuits filed in the Federal Courts of Missouri, by two plaintiffs who did not receive the long-term benefits that were entitled to them under the terms of their respective Plans that were issued and administered by Unum.


Disability Blog & Cases:
Misrepresentation By Claimant Results in Unum Disability Claim Denial

Unum disability claimants need to be aware that when filling out an application for disability insurance benefits it is necessary to disclose your medical history accurately and to make sure your insurance agent is doing the same. Should the insurance company discover a material misrepresentation, the policy could be rescinded, and the claimant could be required to pay back any and all benefits previously paid and then be subject to a fraud investigation…

Disability Blog & Cases:
Medical Doctor suffering from disabling chronic conditions sues AXA Equitable for wrongful denial of disability benefits

A Montana disability lawyer recently filed a federal lawsuit against the AXA Equitable Life Insurance Company (AXA). The Plaintiff, Marise J., M.D., was employed as a licensed medical doctor and was board certified in internal medicine. She had been practicing medicine for over 30 years.


Disability Blog & Cases:
Aetna Disability Denial of Marriott Employee Upheld by Louisiana Federal Judge

A former Marriott Employee was unsuccessful in his lawsuit seeking a reversal of Aetna Life Insurance Company’s disability insurance denial. As a former director of engineering, earning more than $200,000 a year, this former Marriott employee stopped working due to disabling lumbar herniations and back pain…


Disability Blog & Cases:
Who is Making the Decisions on a Sun Life Disability Benefits Claim?

Disability insurance claimants are routinely telling our disability insurance attorneys about their dissatisfaction with the manner in which a disability insurance company has handled their claim for disability benefits. Let’s take a look at why this disappointment is taking place.


FAQ: Tax Issues
How can a claimant exclude their disability insurance benefit payments from Federal Income Tax?

What actions can a claimant take in order to exclude Disability Insurance Benefits from personal income tax?

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.

Disability Blog & Cases:
Assistant Vice President of Meadowbrook Insurance Group files a lawsuit against CIGNA for denied disability benefits claim

In a lawsuit against CIGNA Group, Paul M. and his Massachusetts disability lawyer allege that the insurer is guilty of…


Disability Blog & Cases:
56-year-old disabled District Manager of Dollar Financial Group sues AETNA for denial of disability benefits

Carmen R. and her Florida disability lawyer take AETNA to task in a suit filed on December 19, 2011 in the United States District Court for the Southern District of Florida Fort Lauderdale Division. Claiming AETNA violated ERISA and other employment laws, Carmen and her lawyer accuse the insurer of wrongfully denying Carmen her entitled long term disability benefits after she became unable to perform her job duties as a result of degenerative and traumatic injuries.


Disability Blog & Cases:
Hartford interview request is a trap used to support a disability denial

As disability attorneys that have handled hundreds of Hartford disability claim denials nationwide, we are always trying to warn Hartford disability claimants about the claim handling tactics used by Hartford. Hartford handles every disability claim in a similar manner and they can be relentless in their pursuit of a claim denial. Our suggestion is to never allow a Hartford employee to interview you without representation…


Disability Blog & Cases:
Liberty Mutual Disability Denial Of Wachovia Employee Upheld By Appellate Court

This case is another reminder of the importance to comply with ERISA disability Appeal time deadlines. Plaintiff was a commissioned securities broker for Wachovia Corporation, and a participant in Wachovia’s Long Term Disability Plan (“the Plan”). Liberty Mutual was the administrator of the plan. He was awarded Long term disability benefits in 2005, though he disputed the amount he was being paid monthly.


Disability Blog & Cases:
Lincoln Financial Disability Denial: Determining a Date of Disability is Critical

Applying for disability insurance benefits is a complex process that requires a claimant to be familiar with all of the requirements in a disability policy. We often see that disability claims are denied benefits because a claimant does not select the correct date of disability.

Disability Blog & Cases:
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.


FAQ: Disability Policy Language
What should I be aware of if I am buying a disability insurance policy?

It is important to take into consideration that every disability income policy may have different features.


FAQ: Disability Companies
What are the differences between an individual disability insurance policy and an ERISA / Group disability policy?

Most group disability policies (also known as ERISA policies) are governed by a very complex federal statute called the Employees Retirement Income Securities Act (“ERISA”). An individual usually has a disability policy governed by ERISA, if they received the disability policy as an employee benefit from an employer.

 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.

Disability Blog & Cases:
CIGNA faces a lawsuit by American Homecare Supply Respiratory therapist for termination of disability benefits

In a December 2, 2011 lawsuit filed in the United States District Court for the Middle District of Pennsylvania, Sharon H. and her Pennsylvania disability attorney allege that CIGNA Group Insurance unjustly terminated Sharon H.’s disability benefits.


Disability Blog & Cases:
Long time Bank of America employee sues AETNA for denial of disability benefits

Filing a lawsuit under ERISA (the Employee Retirement Insurance Security Act of 1974) against AETNA, Leslie R, and her Arizona disability lawyer accuse the insurer of operating under a conflict of interest in the denial of Leslie R.’s short term disability benefits. As the decision maker and payor of benefits, AETNA has a bias toward denying benefits. And, according to Leslie R.’s disability lawyer in such incidents like Leslie R., the insurer is inclined to deny short term disability benefits in an effort to not have to follow through with long term disability benefits payments.


Disability Blog & Cases:
Sedgwick continues to deny disability benefits to AT&T employee

An AT&T employee recently shared her experience about dealing with Sedgwick for a short term disability claim. This story is a routine situation for people that are forced to deal with Sedgwick for the handling of their disability insurance claim.

Disability Blog & Cases:
Office Depot employee files suit against employer and Aetna for unpaid disability benefits

An Office Depot employee and her Georgia disability attorney filed suit against her employer and Aetna Life Insurance for unpaid disability benefits on November 3, 2011 in the United States District Court for the Northern District of Georgia Atlanta Division.


Disability Blog & Cases:
New Jersey BankUnited employee files suit against Lincoln National

Robert B. and his New Jersey disability lawyer go to battle against The Lincoln National Life Insurance Company to retrieve Robert B.’s entitled disability benefits as promised in his employee disability benefits plan.


Disability Blog & Cases:
New Jersey claimant files suit against New York Life, Unum and Paul Revere for miscalculated disability benefits

William M. never suspected that should he need to make use of his disability insurance policy (which he had faithfully paid premiums on for years) that the promised disability benefits would be denied him when he needed them most.

A sales representative for Long Forms, Inc., President and part owner of Advanced Transportation Systems, Inc. and The Institute of Logistical Management as well as an hourly employee of Temple University as a Criminal Justice instructor, William was diagnosed with Hodgkin’s’ Lymphoma in 1997. Between January 1997 and February 1998, William underwent surgeries, biopsies, chemotherapy, and radiation to combat the progression of the disease.

Disability Blog & Cases:
Northwestern Mutual sued by shareholder attorney for underpaying and denying long-term disability benefits

A Washington disability attorney filed a federal lawsuit in the District Court serving the Western District Court of Washington at Seattle against Northwestern Mutual Life Insurance Company (Northwestern). The Plaintiff, Scott D., worked as a shareholder attorney at a law firm in the state of Washington. Plaintiff was covered under a long-term disability policy purchased from Northwestern, who was contracted by the law firm to provide these benefits to its employees.


Disability Blog & Cases:
Bank of America, Boeing, and Cytec Industries employees file lawsuits against Aetna Life Insurance Company over disability benefits

Recently, three separate ERISA actions were filed against Aetna in Federal Court for wrongfully denying disability benefits to those covered under Aetna Long Term Disability Policies. Lets take a closer look at each of these cases.


Disability Blog & Cases:
Dental surgeon sues Paul Revere Life Insurance Company for wrongful denial of long-term disability benefits

A California disability lawyer filed a federal lawsuit in Federal Court against The Paul Revere Life Insurance Company (Paul Revere). The Plaintiff, Eric W., DDS, was employed as a dental surgeon and took out an individual long-term disability coverage policy by Paul Revere. The Plaintiff had paid all premiums on time, making him eligible for all benefits covered by the terms of the policy.

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;
  • Damages;
  • 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.