Aetna is one of the nation’s largest managed health care companies. Aetna sells health care insurance and related services, including short term and long term disability benefits plans, primarily through employer paid insurance plans.
Aetna is notorious for denying workers’ claims for disability benefits, having one of the highest rate of disability claim denials. In 2018, during an investigation by the California Department of Insurance, a former medical director for Aetna revealed that he never reviewed any patients’ medical records when deciding whether to approve or deny claims for coverage. It’s easy to understand why the company has been fined millions of dollars by juries and state insurance boards all over the US for its unethical business practices.
ERISA and Disability Benefits Claims
Disability Benefits Lawyer Marc Whitehead recently filed suit on behalf of a disabled Texas worker who became unable to work due to an illness. The worker was covered under a long term disability insurance policy issued and administered by Aetna. Aetna denied his claim.
Our client’s disability insurance policy is governed by the Employee Retirement Income Security Act of 1974, or ERISA. ERISA is a federal law that sets minimum standards meant to protect individuals with private industry retirement and health plans. Among other things, it requires insurers to establish a grievance and appeals process for participants to get benefits and gives participants the right to sue for benefits and breaches of fiduciary duty.
If you are forced to file a claim against Aetna or another major disability insurance company, your claim will probably be governed under ERISA’s technical and difficult rules. Failing to understand the importance of the administrative appeal process that is required by ERISA could cost you your benefits. That’s because disability insurance companies such as Unum, Cigna, Aetna, Prudential and others often write their policies so as to take full advantage of ERISA rules and regulations to make it difficult for a disabled person to either receive benefits or to keep them for the entire length of the term of their insurance policy. Other big names in the short and long-term disability insurance market include The Hartford, Standard Insurance, Sun Life, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.
In the case of the disabled Texas worker, we were able to secure our client’s disability benefits on appeal. His situation points out the need for experienced legal representation when appealing a denial of benefits for an insurance plan governed by ERISA. The disability claims attorneys at Marc Whitehead & Associates know ERISA’s many rules and regulations and how insurance companies use them avoid paying policyholder disability claims. If you’re a disabled worker or veteran, don’t go through the claims process alone – we urge you to reach out to Marc Whitehead & Associates to help you get the disability benefits you deserve.