A large number of disability claim applications that are filed with Aetna do not pass the investigation phase. Applicants who want to continue the claim process after an initial denial must file an appeal, usually within 180 days. The first step toward filing an appeal is understanding why Aetna denied the claim.
Denials are often based on one of four justifications:
- Aetna believes there is insufficient medical justification for your disability claim. For example, with this denial, Aetna might argue that MRIs or other diagnostic tests are inconclusive regarding your disabilities or that there is no proof of your chronic pain or discomfort. Consult an experienced disability claims denial attorney for strategies to appeal medical justification denials.
- Your disability does not coincide with the definition of “disability” in your Aetna policy. This denial will depend on whether that definition includes “own occupation” wording, where your coverage applies if you are unable to perform the duties of your own specific job. Or “any occupation” language provides coverage only if you cannot do any job.
- Your disabilities are abating, and you are showing medical improvement, in which case you are no longer considered disabled.
- Aetna has conducted an investigation of your post-disability activities and surveillance that shows you performing tasks that are inconsistent with your claimed disabilities.
The denial letter that Aetna sent you will include a description of the reason. For example, the denial is based on an insufficient medical justification. Then your appeal may need to include the results of additional diagnostic medical tests and occupational examinations to demonstrate the scope of your disability and how it keeps you from doing your job.
Contact us for a free consultation. We serve clients nationwide.
For a free legal consultation, call 800-562-9830
Your disability claims attorney can also give you guidance on what you should do and avoid doing after you submit your application to Aetna. Information about your day-to-day activities that you post on social media, for example, can be easily misinterpreted as you are not suffering from a disability that would justify benefits. Therefore, your appeal might need to include an explanation of your public activities and of how a broad brush view of those activities does not reflect the extent of your disability.
Call or text 800-562-9830 or complete a Free Case Evaluation form
