Woman suing insurer for failure to pay disability claim
Having disability insurance, whether through your employer or an individual plan, does not guarantee that you’ll be paid the money you deserve if you need to file a claim. Insurance companies don’t want to pay out if they don’t have to. That means that they too often fight customers who file a perfectly valid claim.
One case in Louisiana exemplifies how this can be a problem. In this instance, the woman who filed the claim is taking the insurance company to court. According to her lawsuit, she “has exhausted her administrative remedies” to get the money to which she believes she’s entitled. She is seeking past as well as future benefits in addition to her legal costs.
The woman purchased disability insurance through her employer’s group plan. That employer is Capital One. The insurer is Aetna Life Insurance Co.
The woman was determined by the Social Security Administration to be disabled. However, her disability claim was denied by Aetna. According to the suit, she has had multiple surgeries on her spine. That condition, diagnosed as “severe degenerative disc disease with complications like arachnoiditis,” reportedly has left her unable to do her job.
Arachnoiditis may sound like something you’d get after being bitten by a giant radioactive spider. However, according to WebMD, it is a “pain disorder caused by the inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord.” In addition to neurological problems, it can cause burning, stinging pain. According to her suit, the woman requires “comprehensive pain management treatment” for her condition.
When you’re living with an illness or disability and trying to manage or recover from it, the last thing you want to do is fight your insurance company to get the money you need to support yourself and your family as well as pay your medical bills. Although having to take the insurer to court is never anyone’s first or favorite option, it may be necessary.
Source: Louisiana Record, “Disabled woman sues over disability claim denial,” Dan Harkins, July 15, 2015