HELPING THE DISABLED FROM COAST TO COAST

Aetna Insurance Individual and Group Disability Claim Denials

Was Your Aetna Claim Delayed, Denied, or Devalued?

Insurance companies win when you don’t fight back! In any one year, Aetna collects more than $30 billion dollars in premium revenue. Unfortunately, despite what seems like a clear financial ability to pay valid disability claims, Aetna—and other big insurance companies—continue to delay and deny coverage. If you submitted a claim for disability insurance benefits to Aetna and were delayed or denied at either the initial stage or after an appeal, you are not alone. DarrasLaw is here to help.

Aetna—and other huge disability insurance carriers—understand that they can often increase profits by denying legitimate claims or by giving policyholders the eternal runaround. Unfortunately, insurance companies act in bad faith more often than you might imagine. By denying valid disability claims outright or convincing policyholders to settle claims for less money, insurers bank on you not putting up much of a fight. If you believe Aetna has unfairly treated you, we are here to help.

 

At DarrasLaw, we have recovered nearly $1 billion in disability insurance benefits on behalf of individuals just like you, who thought they were protected only to be gamed by their insurer. Contact our top-rated law firm online today or at (800) 458-4577 for immediate help with your Aetna disability claim.

Understanding Long-Term Disability (LTD) Policy Provisions and Claims with Aetna

Long-term disability (LTD) insurance benefits provide beneficiaries with a portion of their income in the event that they cannot work for an extended period—due to a covered sickness or accidental disability. Aetna expressly provides certain disability insurance limitations including:

  • Only certain illnesses or injuries are covered under your plan.
  • You need to miss a certain number of workdays before your disability benefit begins to satisfy the elimination period.
  • Disability insurance benefits last for a specific period of time. Your age at the time you became disabled will determine how long benefits last.
  • Aetna may require you to undergo rehabilitation services to help you return to work.
  • Other income you receive or are eligible to receive during your disability may affect the amount of disability benefits you receive.
  • The amount of disability insurance benefits you receive is usually based on your annual salary, commissions, and other forms of income or bonuses from your employer, depending on your disability plan.

 

Aetna’s disability policies generally provide even more information regarding LTD limitations and exclusions. Usually, after 24 months, Aetna expressly limits eligibility for long-term monthly disability insurance benefits, if your disability is primarily caused by or contributed to by:

  • A mental health or psychiatric condition (unless the condition includes structural brain damage).
  • Alcohol and/or substance (drug) abuse.

 

There are two exceptions to the above limitations—if you are confined as an inpatient in a hospital or facility for treatment of that condition at the end of such 24 months. When the claimant is hospitalized at the end of the 24-month benefit period:

 

  1. If the inpatient confinement lasts less than 30 days, the disability will cease when you are no longer confined

-OR-

  1. If the inpatient confinement lasts 30 days or more, the disability may continue until 90 days after the date you have not been so continuously confined.

In addition, Aetna generally expressly excludes group LTD benefits for any period that a claimant is in jail—or some other correctional institution—as the result of an imposed sentence for a criminal act or public offense. Despite the health condition you may find yourself in during this time, Aetna will not consider you disabled pursuant to this exclusion, check your coverage to be sure.

Lastly, Aetna’s group LTD coverage usually does not extend to any disability that is:

  1. Due to insurrection, rebellion, a riot or civil commotion.
  2. Due to intentional, self-inflicted injury (despite clinical, mental status as sane or insane).
  3. Due to war or any act of war.
  4. Due to a criminal act or an attempted criminal act.
  5. The result of a vehicle accident in which you were the driver or operator and under the influence of alcohol. A motor vehicle accident will be deemed to be caused by the use of alcohol if you are found in excess of the applicable state’s legal limits.

Find information from Aetna’s disability insurance webpage here.

 

Find Aetna’s disability insurance limitations and exclusions (as found generally in its policies) here.

How Long Is Too Long? Aetna Is Delaying My Claim- What Do I Do?

It is a common misconception that insurance companies make the bulk of their money from the premiums that policyholders pay monthly or annually. In truth, insurance companies often invest your money and the money of other premium paying policyholders, in ways that allow them to make even more money. Ultimately, the money that insurance companies’ pay out is a fraction of what they receive and the premiums paid by policyholders are only a fraction of the revenue these companies earn.

What this means for you is that disability insurance companies can profit from delaying claims. While each individual claim may only account for a fraction of the money against an insurer’s reserve, these claims add up. If insurance companies paid all legitimate claims in a timely way, they would have less money to invest into other ventures and, thereby, lose or make less money. By delaying legitimate claims using various arbitrary and capricious tactics, insurance companies can seek to hold onto your benefits. Experienced disability insurance delay lawyers can help ensure that Aetna—or any other disability insurance company—doesn’t play these games with you. Please contact an experienced disability insurance lawyer or ERISA attorney today, if you feel that Aetna is delaying your claims unreasonably.

Did You Receive a Claim Denial Letter from Aetna?

The trial attorneys at DarrasLaw are not afraid of large disability insurance companies. We stand by your side, as your advocate, as we pursue compensation for your wrongfully denied disability claim. Disability insurers are required to act in good faith and to deal fairly with their insureds—the law requires that. This means that insurance companies should not get away with simply looking for ways to avoid paying legitimate claims—this unlawful practice is known as acting in bad faith. If Aetna has failed to meet its obligations by delaying, denying, devaluing or terminating your claim, our top-rated disability insurance bad faith lawyers offer free consultations to discuss your situation.

Whether you are covered under an individual or group disability plan by Aetna, our nationally recognized team of disability insurance attorneys and ERISA Lawyers can help fight for the coverage you have paid for. At DarrasLaw, we can evaluate disability cases nationwide that involve:

  • Delayed payments without proper legal justification
  • Non-responsiveness to the policyholder’s requests
  • Attempts to bury you in a mountain of paperwork by sending endless requests for duplicative additional information
  • Independent Medical Examinations (IME) by Aetna with doctors in the wrong specialty
  • Functional Capacity Evaluations (FCE) by Aetna that are located too far away
  • Non-compliance with ERISA regulations on your group policy
  • Discarded or completely ignored new medical information that supports your claim
  • Video surveillance of you by Aetna
  • Offers to settle your claim for substantially less than you are entitled, or that are owed under the terms of your policy
  • Misinterpretation of the provisions of your Aetna policy
  • Minimizing the objective and subjective medical problems that prevent you from working

Appealing a Claim Denial from Aetna

Appeals are essentially requests for a fresh look at a denied claim. With Aetna, policyholders who have received a claim denial may initiate an appeal:

 

  1. To submit your request in writing, you can print and mail the appeals form. For this form, click here.
  2. Always get a free appeal consultation before sending in your appeal from a nationally recognized ERISA attorney.

 

Either you or someone you authorize may submit an appeal regarding your denial. You will generally have 180 days from the time you receive the notice of the denied claim (to be safe, refer to the postmarked date). In certain cases, plan policies may give shorter and longer times; refer to that time, if this applies to you. An experienced disability insurance attorney that handles ERISA cases can help you meet and understand these deadlines.

 

Aetna generally gives specific information that you must include in your written request for appeal:

  • The group name (usually your employer or organization that sponsors your plan)
  • Your name
  • Any and all medical documents, pharmacy and testing records and other information you would like the carrier to consider showing you are unable to work

 

For more information on writing your initial appeal, click here—or call DarrasLaw for help.

I Have Exhausted My Appeals. What Else Can I Do?

If you have timely exhausted the appeals that your plan affords you, you may file your individual complaint or group ERISA complaint for benefits.

Have You Heard of ERISA?

The Employee Retirement Income Security Act of 1974 (ERISA) is a wide-ranging federal statute that applies to U.S. employee disability insurance benefit plans when those plans are provided by private employers or labor unions. Like other parts of an employee’s benefit package, disability insurance plans are subject to ERISA. Pertinent parts of ERISA include reporting and disclosure rules along with certain prohibited transactions.

Aetna can face liability, under ERISA provisions, for not telling you enough about your disability plan. Aetna has a duty to make you aware of your policy provisions in ways that the courts deem adequate.

A denial of group disability coverage by Aetna will typically fall under ERISA. ERISA was enacted to protect workers; but insurers often try to use it to hurt disabled workers by denying valid disability claims.

ERISA presents a complex system for both employers and employees. For policyholders of ERISA-regulated disability insurance plans, ERISA establishes strict rules for filing, documenting and appealing claims. It requires very strict compliance with many specific deadlines and submissions. If you are governed by an ERISA disability insurance plan, ERISA requires that you submit a timely appeal, in writing, generally within 180 days of the denial. Failing to timely and thoroughly appeal—according to your jurisdictions ERISA guidelines—could affect your ability to file a suit in court later.

At DarrasLaw, we understand ERISA laws and every type of disability insurance coverage. When you are denied coverage by Aetna, you can fight back and win. Our experienced ERISA disability insurance lawyers can help.

Lawsuits That Aetna Has Faced

Sherrie Ace v. Aetna Life Insurance Company (1998)

Sherrie Ace alleged that Aetna acted in bad faith when the company denied her claim for disability insurance benefits. Ultimately, the jury ruled in Ace’s favor on her bad faith claim, awarding her a sum of $27,000 for the wrongful denial of her individual disability insurance benefits and $100,000 for emotional distress.

 

The district court stated that Aetna acted “with enough disregard for Ace’s interest to represent bad faith.”

 

On appeal, the appellate court even criticized the lower court for failing to take into account “substantial evidence from which a jury could reasonably have found, clearly and convincingly, that Aetna acted with reckless indifference to Ace’s interests.”

 

The appellate court looked to the following bad faith conduct by Aetna (as cited in the decision):

  1. Basing denial of the claim on an illegal standard for disability insurance benefit eligibility;
  2. Failing to inform the claimant of the standard procedures actually used by Aetna in evaluating disability claims;
  3. Failing to investigate the claim and to seek or request the supporting information alleged to be missing;
  4. Failing to assist the claimant in presenting her individual disability claim;
  5. Relying on an outdated prognosis of the claimant’s expected recovery and disregarding recent reports of her actual condition;
  6. Denying her claim based on an undefined “requirement,” not a term of her policy and contrary to Aetna’s internal claim adjustment guidelines;
  7. Falsely advising the claimant that Aetna had no claim adjustment guidelines; and
  8. Making a last-minute demand for an IME after having denied the claim.

 

For more information about this landmark individual disability case, click here.

 

Robert Skaling et al. v. Aetna Insurance Company et al. (2002)

On August 26, 1996, Robert Skaling (the plaintiff) alleged that Aetna breached its contract with him by refusing to pay his insurance claim and by acting in bad faith in the investigation and handling of his disability claim. The lower court, and the higher court upon appeal, agreed that Aetna had breached its contract with Skaling. For more about this case, click here.

Nationwide Disability Insurance Attorneys: Fighting Back Against Wrongful Aetna Denials

The disability insurance lawyers at DarrasLaw are widely considered the nation’s top disability litigation firm. We take on large insurance companies who wrongfully deny much needed and deserved disability insurance benefits — and win. Top-rated trial lawyer Frank N. Darras and his team handle a wide spectrum of individual, short-term and long-term disability insurance claim denials, from a few thousand dollars — to claims worth millions. We have an unmatched track record of forcing insurers like Aetna to fulfill their contractual obligations.

Our nationwide disability insurance bad faith attorneys and ERISA lawyers evaluate cases against every major insurance company. We are here to help fight for your disability insurance benefits when your insurer has let you down. We have recovered nearly $1 billion in wrongfully denied insurance benefits.


Testimonial

Review: 5/5 – ★ ★ ★ ★ ★

“Dear Frank and Heather: Who would have ever thought that you could get disability insurance on a retroactive basis? I didn’t even think of it and when you and Heather suggested it at our initial meeting, I was skeptical, at the very least. Needless to say, Aetna has agreed to pay me full disability going back to the retroactive date Heather had suggested we use, which is beyond my wildest dreams in terms of the overall benefit being paid by Aetna. I want to thank you both, once again, for the wonderful counseling you gave me. Please take the enclosed gift as a small token of my appreciation (the blue ribbon is for Frank and the pink is for Heather). Once again, thank you so much for your wisdom and counsel. Best Regards. Sincerely”

– Steven Y.


If you were given the runaround by Aetna or received a denial of your disability insurance claim, contact our law firm today. DarrasLaw is America’s top disability law firm because we help people, just like you, secure the disability insurance benefits you deserve after becoming disabled. You held up your end of the insurance bargain when your disability premiums were timely paid — we make sure that Aetna holds up their end by paying you all that they owe.

For a free claim consultation, contact DarrasLaw online or all us at (800) 458-4577. If you are considering purchasing an Aetna individual or long-term disability policy, call us for a free policy analysis.

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Why Choose DarrasLaw?

DarrasLaw brings more than 30 years of passionately representing disabled people against every insurance carrier.

Call our experienced, top-rated national disability attorneys at 800-458-4577 or send us an email.

We offer free consultations on all insurance matters, including free policy analysis and free claim help.

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