Disability Lawyer, Marc Whitehead has filed suit against Aetna 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.
Our client was formerly employed as a Director of Cardiopulmonary and is currently disabled due to degenerative disc disease, post laminectomy syndrome and chronic back pain. Aetna is an insurance company doing business in Texas.
Jurisdiction of Long Term Disability Lawsuit
This lawsuit was filed in federal court in Texas pursuant to 28 U.S.C. § 1331. Specifically, this action was brought to enforce our client’s rights under the Employee Retirement Income Security Act ERISA, as allowed by 29 U.S.C. §§ 1132, 1133, & 1140.
Allegations of Wrongful Denial of Disability Benefits Under ERISA:
Marc Whitehead & Associates filed this lawsuit to help our client secure all long term disability insurance benefits to which he is entitled under a disability insurance policy underwritten and administered by Aetna. He was covered under the policy through his employer.
On February 13, 2012, Aetna notified our client they stood by their original decision to deny long term disability benefits, totally ignoring the findings of the Social Security Administration..
Aetna also notified our client that he had exhausted all administrative options to appeal the denial and that they would consider no further claims or evidence. Aetna, in its final denial, discounted the opinions of our client’s treating physicians, among others, and the documented limitations from which he suffers, which includes how his impairments affect his ability to engage in work activities.
Because our client has now exhausted all available administrative remedies, and he is forced to file a lawsuit to obtain his rightfully owed disability benefits.
The Law – The Employee Retirement Income Securities Act (ERISA)
This claim is governed under ERISA because the plaintiff is covered under an insurance policy issued through his employee benefits plan. ERISA, which stands for the Employee Retirement Income Security Act of 1974, 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.
Marc Whitehead’s Comments:
The complex laws and procedures that govern disability insurance claims are full of traps for the unwary, including for attorneys who are not experienced in handling claims under ERISA law. Most people think they can handle the administrative appeal themselves and then hire a disability lawyer if they lose and have to file a lawsuit. This is one of the biggest mistakes you can make and may very well ruin any chance you have of a successful appeal.
Recently I had a client come to me with such a claim. He said, “don’t worry about the administrative appeal, I filed it myself. I just need you to file my lawsuit.” It turns out he filed a one page letter asking the insurance company to reconsider because he “really was disabled.”
He was astonished to learn that this one page letter was the only evidence the judge could consider in his case other than what the insurance company chose to include when they denied him. In other words, he had blown any chance to present his case in court.
Please don’t let this happen to you. If you don’t call us, call someone.
To consult with Texas long term disability attorney Marc Whitehead, call 800-562-9830. You may also download our free ebook “Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.”