In this video Marc Whitehead, a Board Certified Disability Attorney, explains how a claimant can win a long term disability insurance claim against Aetna.
A Federal judge recently reviewed a Long Term Disability termination from Aetna and determined an abuse of discretion in its review of the claim. The judge then ordered that benefits be paid to the claimant. The policy holder suffered from a condition causing involuntary head movements. In previous years he had suffered from the same condition but was successfully treated but in 2006 the condition returned and, even after treatment, the claimant was unable to work.
While Aetna acknowledged that the claimants occupation as a baggage handler for Continental Airlines was a physically demanding job. Their medical review of the file didn’t mention any limitations that would prevent his ability to work his past job as a baggage handler.
The Aetna representative assigned to this claim disagreed with Aetna’s medical review and recommend the claimant receive benefits. The claimant did begin receiving benefits but only for a short amount of time. Then Aetna continued their investigation of the claim, including requiring a Functional Capacity Evaluation (FCE). This found him capable of light work, even though the SSA examination found him disabled and unable to do any occupation.
Aetna then chose to obtain a paper review of the file rather then having the claimant examined by a doctor. The paper review found the claimant had functionality. Next Aetna conducted a transferable skills analysis find the claimant capable of performing certain jobs. This was Aetna’s reasoning for denying the claimants disability benefits.
When this claim was reviewed in court Aetna was found to have a conflict of interest in the handling of this claim also stating they lacked substantial evidence to support that the claimant could preform any job.
Marc Whitehead & Associates have extensive experience in handling claims that have been denied the way this case was. Any Occupation disability appeals are complicated, in order to improve your chances of winning a claim you need strong representation by an experienced disability attorney.
Marc Whitehead & Associates is a National Disability Law Firm representing disabled individuals on all 50 states with over 20 years of experience fighting for our clients.
