The high road, or in this case, high flight taken toward group disability insurance went terribly wrong for a Tennessee helicopter pilot who thought the better of his substance abuse, and temporarily grounded his flying career to seek treatment.
But in the case of the pilot, it seems the good deed of doing the right thing both for his safety and others, was punishable and Aetna denied him long-term disability insurance while he recovered.
In response, the pilot filed a lawsuit against the provider for improperly denying him insurance benefits.
The helicopter pilot’s employer, the Bristow Group, held a group disability plan which was underwritten by Aetna. Then, in April of 2012, the plaintiff decided to take off work due to his issues with substance abuse and depression. As a consequence, the pilot was treated with a selective serotonin reuptake inhibitor or SSRI, which the Federal Aviation Administration has deemed as enough to disqualify a pilot from flying.
According to Aetna’s insurance plan, a pilot must be disabled by way of a mental or physical condition in order to garner 36 months of disability insurance only if the FAA deems that pilot unfit to fly.
The lawsuit states that the man’s initial request for coverage was denied due to his not receiving treatment that fell within the insurance policy’s guidelines. Although Simmons did see a therapist on a regular basis, Aetna concluded his visits were to deal more with his depression than his substance abuse.
To this end, an internal appeal was filed with Aetna in May of 2013, which highlighted that beyond his substance abuse, the pilot’s depression alone should make him eligible for benefits under the FAA regulations.
Long-term disability insurance can be complicated, if not tricky, and insurance companies know this. When involved in a disputed LTD claim, or even when filing a new claim, the aid of legal experts may prove worthwhile.
Source: Medbill.net, “Tennessee Resident Sues Aetna after Disability Benefits are Denied” No author given, Aug. 17, 2013