Disability Lawyer Marc Whitehead recently represented a worker in a lawsuit against Aetna. The worker became severely disabled and was denied benefits while covered under a long term disability insurance policy issued and administered by Aetna Life.
Our client was a 54-year-old worker who lives in Massapequa Park, New York, and was formerly employed by Delta Airlines as a customer service agent. He was disabled due to a fractured spine, a herniated disc, cervical radiculopathy and lumbosacral radiculopathy. The aforementioned impairments and their symptoms prevented our client from performing any work activities on a consistent basis.
Our client was forced to take action to secure all long term disability insurance benefits to which he was entitled under a disability insurance policy underwritten and administered by Aetna Life.
The defendant in our case was the Aetna Life Insurance Company, commonly referred to as Aetna Life, an insurance company based in New York.
Allegations of Wrongful Denial of Disability Benefits Under ERISA
Our client was covered under the policy by virtue of being an employee of Delta Airlines Inc.
Originally, Aetna Life had notified our client that they had granted his request for disability benefits under the Plan based on the “Own Occupation” standard of disability.
The Social Security Administration had also issued a fully favorable decision on our client’s claim for Social Security disability benefits under Title II and Title XVI of the Social Security Act, finding that he was “disabled” during the relevant time period (a fact that Aetna Life was aware of).
Subsequently, however, Aetna Life denied further long term disability benefits under the Plan.
Our client appealed Aetna’s decision within the allotted time frame.
Six months after denying our client’s claim, Aetna Life notified him that all administrative remedies had been exhausted and the insurer would consider no further claims or evidence. In its final denial, Aetna discounted the opinions of our client’s treating physicians, among others, and the documented limitations from which our client suffers, including the effects of our client’s impairments on his ability to engage in work activities.
Our client, who had now exhausted all available administrative remedies, decided to file a lawsuit against Aetna to obtain his rightfully owed disability benefits.
Venue and Jurisdiction of Long Term Disability Lawsuit Against Aetna
This claim was governed under the Employee Retirement Income Security Act (ERISA), a federal law that regulates the handling of Employee Benefit Plans and the remedies available to the beneficiaries of these Plans. All state law claims that may have been considered are preempted by federal ERISA law because a plaintiff is covered under an insurance policy issued through his employee benefits plan. 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.
Virtually all long term disability plans offered by private employers 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.
The lawsuit was filed in federal court in the Eastern District of New York pursuant to 28 U.S.C. § 1331 (“The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States”) to our client’s rights under ERISA, as allowed by:
- 29 U.S.C. §§ 1132 (“A civil action may be brought … by a participant or beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan”);
- 29 U.S.C. §§ 1133 (“Every employee benefit plan shall…afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim”); and
- 29 U.S.C. §§ 1140 (“It shall be unlawful for any person to discharge, fine, suspend, expel, discipline, or discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan”).
Get Help from an Experienced Aetna Disability Denial Attorney
“Disability Insurance claims are governed by a complex set of laws and procedures,” says nationally recognized ERISA attorney Marc Whitehead. “These laws are full of traps for the unwary, even attorneys not experienced in ERISA law. Most people make the mistake of thinking they can handle the administrative appeal themselves and then hire a lawyer if they lose and have to file a lawsuit. This is totally backwards thinking. Please don’t let this happen to you.”
If Aetna or another insurance company has denied your claim for disability benefits, we urge you to reach out to Marc Whitehead & Associates at disabilitydenials.com without delay.