Marc Whitehead & Associates recently represented a 48-year-old woman from Savannah, Georgia, after the Aetna Life Insurance Company denied her claim for long term disability (LTD) benefits. We successfully handled her appeal and obtained for our client the benefit payments she was entitled to.
Our client suffered from numerous physical and mental disorders, including thoracic lumbar radiculopathy, fractured ribs, sleep apnea, depression and anxiety. She was forced to manage her severe ongoing pain with nerve blocks, physical therapy, and heavy medication. Her condition left her unable to sit for prolonged periods of time and made it difficult to concentrate. The difficulties she experienced coping with the painful symptoms brought about by her condition often left her with feelings of depression.
In her physician’s opinion, our client’s condition was so serious that she was unable, and would continue to be unable, to perform the duties of any occupation, even a sedentary job.
Our Client Was Unable to Work a Sedentary Job
Aetna rejected her claim. Their opinion, even after reviewing the extensive medical documentation regarding our client’s pain, restrictions and limitations and ongoing treatment, was that she was still able to work in a sedentary capacity. They chose to ignore the effects of her pain and the side effects of her medication.
The Social Security Administration describes sedentary work as an occupation that “involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools.” They go on to state, “Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.”
These occupations require a certain level of productivity, and this is just not something our client can do. Most do not allow their employees to take frequent, unscheduled work breaks due to severe pain as our client was often forced to do in her previous job.
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We Proved Our Client Was Unable to Work
We knew Aetna was not justified in rejecting the opinions of treating physicians as well as our client’s statements. Rather than rely on the opinions of treating physicians, the disability insurance company supported its own conclusions with an unreasonable interpretation of a Functional Capacity Evaluation and an unreasonable vocational assessment.
Most importantly, we had to show that our client’s impairments prevented her from performing any work at all. By researching every medical document, requesting additional testing and physician statements, and carefully reviewing of each statement made by the disability insurance company, we were able to create a solid argument against their denial of our client’s LTD claim.
It wasn’t difficult to gather evidence supporting our client’s claim that her impairments, including the multiple right sided rib fractures that produced unmanageable pain after only minimal stress or movement, render her incapable of performing the duties of even sedentary work.
At our client’s administrative appeal, we submitted testimony from her treating physician that contradicted Aetna’s determination that our client could perform sedentary work. We were also able to supply evidence which demonstrated our client’s inability to perform the duties of any of the sedentary occupations that Aetna suggested she was suited for.
Social Security has already agreed that our client is disabled from any occupation at any level and granted her disability benefits before her LTD insurance benefits were denied. However, Aetna persisted in denying our client’s LTD benefits by asserting that she was physically able to perform the duties of a sedentary occupation.
Although Aetna claimed it did not have the same medical information as the Social Security Administration, we demonstrated that was not true. The disability insurance company had provided representation for our client through Allsup (a 3rd party company that specializes in assisting those with Social Security disability claims) and constantly monitored our client’s progress and SSA disability benefits award. We proved that Aetna could easily have gotten access to our client’s SSA file.
The strength of our evidence prompted a sympathetic senior Aetna appeal specialist to thoroughly re-examine each document we submitted. He agreed that a mistake had been made during the first determination and came back with a decision to overturn their previous Aetna LTD denial and approve benefits for our client.
Get Help From a Aetna LTD Denial Attorney
If you received an Aetna LTD denial of benefits, please contact the law offices of Marc Whitehead & Associates for a free consultation top discuss your situation. Be sure to follow our blog for the latest long term disability insurance news and updates and download a free copy of our soon to be in print e-book, Disability Insurance Policies: How to Unravel the Mystery and Prove Your Claim for even more information!
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