Suit Filed Against AETNA-Long Term Disability Denial

Disability Lawyer, Marc Whitehead has filed suit on behalf of a disabled 57 year old worker and a resident of Texas, who became severely disabled while covered under a long term disability insurance policy issued and administered by AETNA

Plaintiff is a 57 year old worker and was formerly employed as a Director of Cardiopulmonary. Plaintiff is a resident of Texas and is currently disabled due to degenerative disc disease, post laminectomy syndrome in lower spine and associated back pain. AETNA is an insurance company doing business in Texas.

Jurisdiction of Long Term Disability Lawsuit

Suit was filed in federal court in Texas pursuant to 28 U.S.C. § 1331. Specifically, Plaintiff brings this action to enforce plaintiff’s rights under the Employee Retirement Income Security Act ERISA, as allowed by 29 U.S.C. §§ 1132, 1133, & 1140.

If you have questions, ask long term disability attorney, Marc Whitehead by visiting disabilitydenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim

Claimants must prove the insurance company “Abused its Discretion”

In a disability insurance claim brought under state law, the disabled claimant only has to prove it is “more likely than not” that they are disabled. This generally only applies to individually purchased policies. Most policies however are obtained through a worker’s “Employee Benefit Plan.” Employee Benefit Plans are usually governed under ERISA. In most claims brought under ERISA, the claimant must prove that the insurance carrier “Abused its Discretion” when it denied your claim. This is a very tough standard requiring to show the insurance company had “No Reasonable Basis” for denying your claim. An example might be if you had three doctors that said you were disabled and the insurance company only had one that said you were not. The insurance company could legally argue that they had a “reasonable basis” to deny your claim based on their one doctor, in spite of your three.

Disability Insurance companies such as Unum, Cigna, Aetna and Prudential often write their policies so to take full advantage of ERISA rules and regulations to make it difficult for a disabled person to get receive benefits or to keep them for the entire length of the term of their insurance policy. Other insurance companies with a large share of the disability market include The Hartford Standard Insurance, SunLife, MetLife and Liberty Mutual, Provident, CNA, John Hancock, Colonial, AXA Equitable, New York Life, Guardian, Penn Mutual.

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The Law – The Employee Retirement Income Securities Act (ERISA)

This claim is governed under federal ERISA law. All state law claims that may have been considered are preempted by federal ERISA law because the plaintiff is covered under an insurance policy issued through his employee benefits plan. ERISA stands for the Employee Retirement Income Security Act of 1974. ERISA is a federal law that regulates the handling of Employee Benefit Plans and the remedies of the beneficiaries of these Plans. ERISA applies to all employees benefit plans established or maintained by an employer engaged in commerce or by an employee organization representing employees engaged in commerce. Practically all long term disability plans offered by a private employer are governed by ERISA. A claimant challenging a disability denial under an ERISA governed plan or policy must bring the claim pursuant to ERISA regulations and procedures. All state law remedies are preempted, meaning they do not apply to an ERISA claim.

Claimants must prove the insurance company “Abused its Discretion”

Plaintiff brings this action to secure all long term disability insurance benefits, to which Plaintiff is entitled under a disability insurance policy underwritten and administered by AETNA. Plaintiff is covered under the policy by virtue of plaintiff’s employment.

On February 13, 2012 AETNA notified Plaintiff that Defendant affirmed its original decision to deny Plaintiff’s claim for long term disability benefits, totally ignoring the findings of the Social Security Administration.

AETNA also notified Plaintiff on February 13, 2012, that Plaintiff had exhausted all administrative remedies and they would consider no further claims or evidence. AETNA, in its final denial, discounted the opinions of Plaintiff’s treating physicians, among others, and the documented limitations from which Plaintiff suffers including the effects of Plaintiff’s impairments on plaintiff’s ability to engage in work activities. Plaintiff has now exhausted all available administrative remedies, and plaintiff is forced to file a lawsuit to obtain plaintiff’s rightfully owed disability benefits.

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