Aetna Disability Denials

Unfortunately, insurance companies like Aetna do not always live up to their end of the bargain. All too often, we hear from policyholders who have received Aetna disability denials instead of the monthly long-term disability benefits they were counting on. If your claim has been wrongfully denied or terminated, the Aetna long-term disability lawyers at the Ortiz Law Firm will fight to get you the benefits you are entitled to under the terms of your disability policy.

Top Reasons Aetna Denies Long-Term Disability Insurance Claims

Sometimes disability insurance companies like Aetna do not pay benefits as they should. They will look for ways to use the terms and provisions of the policy, such as the definition of disability, to deny your claim. In this video, national disability attorney Nick Ortiz explains why a claimant might receive an Aetna disability denial. The key points of the video are also summarized below.

The Definition of Disability

One of the most common reasons for an Aetna disability denial is a change in the definition of disability. Many disability insurance policies have a definition of disability that changes after a certain period of time, usually after the first 24 months. During the first 24 months, you must prove that you cannot perform your own job. After 24 months, you must prove that you cannot perform any job.

Each policy has a different definition of disability, so you’ll need to check how this term is defined in your policy. Many important terms and policy provisions that will affect your disability case vary between different disability insurance policies, so you must obtain a copy of your policy from the insurance company and review it carefully.

Medical Improvement

Aetna may also terminate your claim based on medical improvement. The insurer may determine that your condition has improved enough for you to return to work and deny future long-term disability benefits.

Insufficient Medical Evidence

Another reason for an Aetna disability denial is insufficient medical evidence. A letter from your doctor stating that you are unable to work is not enough. You will need to provide evidence to support your symptoms and resulting limitations. Aetna is one of many insurance companies that have gained a reputation for denying claims by claiming that there was missing information or documentation.

Using Your Doctors Against You

Aetna may also use your doctors against you to deny your long-term disability insurance claim. Aetna will ask your doctors to fill out paperwork and may even try to discuss your claim over the phone. It is possible that your doctor could misunderstand the paperwork, or a statement made over the phone could be misinterpreted by the insurance company.

Surveillance

Another tactic Aetna uses to deny long-term disability insurance claims is conducting surveillance. Aetna may hire a private investigator to conduct video surveillance of your activities. If Aetna determines that your activities are inconsistent with the limitations you have stated in support of your disability claim, your claim will likely be denied.

Insurance companies are in business to make money. They do this by collecting more in premiums than they pay out in benefits. The fewer claims they pay out, the more profit the insurance companies keep for their shareholders. Understanding this basic premise will help you understand why even the best prepared disability claims can be denied. It is not personal to you.

Appealing Aetna Disability Denials

If you receive a denial letter in response to your claim, or if your benefits are terminated early, do not despair and give up. If your claim is denied, you can file an appeal directly to Aetna through its internal appeals review process. You may even have the option to file more than one appeal. After you have “exhausted” your appeals, you may file an ERISA lawsuit.

If you have an individual disability insurance policy that you purchased on your own (outside of a group disability plan), or if you are a government employee or a member of a church plan, you may be exempt from ERISA disability law and have the right to file a lawsuit in state court, which give you, the consumer, greater protections in disability claims than an ERISA claim in federal court.

This is why it is important to hire a lawyer to explain your legal options to you. Most disability attorneys offer a free case evaluation. Mr. Ortiz and his experienced legal team provide detailed advice to disabled individuals throughout the administrative appeal and litigation process and will help you to:

• Understand the reasons for Aetna’s denial of your disability claim;
• Obtain additional medical records and evidence to submit with the appeal;
• Obtain opinions from your treating physicians regarding your impairments resulting from your injury or illness;
• Complete the appeal paperwork;
• File your appeal within the required time limits;
• File an ERISA lawsuit in federal court or a breach of contract lawsuit in state court; and
• Prepare your case for trial.

While there are no guarantees that your appeal of a long-term disability insurance claim denial will be approved on the first try, we will work diligently to help you file a claim that is clear, concise, and complete with all necessary information.

Aetna Federal Court Case Summaries

The court cases summarized here are intended to help you understand how federal courts decide ERISA long-term disability claims.

• Cannon v. Aetna – Aetna Not Bound By SSA Disability Determination
• Gaines v. Aetna – Court Rules Aetna Refused to Credit Reliable Evidence
• Robinson v. Aetna – Claim Remanded to Insurer to Evaluate Disability Under “Any Occupation” Definition
• Cassidy v. Aetna – Court Finds There Is a Difference Between Diagnosis and Limitation
• Mozdziers v. Aetna – Video Surveillance May Provide Significant Support for Denial of LTD Claims
• Young v. Aetna – Aetna Committed Abuse of Discretion in Denying Plaintiff’s LTD Claim
• Patterson v. Aetna – Court Rules “Own Occupation” and “Regular Occupation” Are Interchangeable
• Neno v. Aetna – Court Finds No Abuse of Discretion
• Mercado v. Aetna – Court Finds Denial of LTD Claim Reasonable
• Murphy v. Aetna – Claim Denied Under “Any Occupation” Standard

Hire a Long-Term Disability Attorney

As mentioned above, many individuals who apply for disability insurance benefits are shocked and dismayed by the hurdles Aetna places in front of them during the disability claim process. Aetna demands more and more paperwork as part of the “proof of loss” process.

Just when you think you’ve filled out the last form, you get another one. Your doctor may start to get annoyed with Aetna’s phone calls and numerous requests for the doctor to fill out paperwork. Then, after all the paperwork is finally finished, your claim is denied by Aetna, and you receive a disability denial letter in the mail.

At the Ortiz Law Firm, we know how difficult it can be to deal with all the paperwork involved in filing a disability insurance claim and proving your loss. You have enough to worry about the treatment of your injury or illness. We also understand how important these disability insurance payments are to you and your family when you are unable to work and earn an income.

Let us take the burden of fighting the insurance company off your shoulders. With over a decade of experience in dealing with insurance companies and disability insurance policies, our Aetna long-term disability lawyer has the skills and knowledge needed to help you understand your rights under your policy and pursue the benefits you deserve.

The Ortiz Law Firm Will Fight Back Against Aetna Disability Denials

Many disability insurance claims are denied, or your claim may be initially approved and then prematurely terminated. That’s when the Ortiz Law Firm can help. We are a national disability law firm that represents individuals whose disability insurance claims have been wrongfully denied or terminated. 

If you have received a disability denial letter from Aetna, you should call us as soon as possible to schedule a free case evaluation with an experienced disability attorney. Disability claim denials are not the end of the process. Our disability lawyers are experts in disability law and will fight to get you the long-term disability benefits you deserve from Aetna.

Working with an experienced disability attorney can be the difference between winning and losing your disability claim with the disability insurance company. We also handle Social Security Disability Insurance claims, so we can help you with both of your disability claims if your insurer requires you to apply for Social Security Disability Insurance.

If your Aetna insurance claim has been denied or terminated, we can help. Our firm has represented numerous clients in claims against Aetna for disability insurance coverage. We may not be the largest firm, but we have years of experience representing disability claimants who have had their claims denied or terminated. 

Call us at (888) 321-8131 to request a free case evaluation to discuss your Aetna disability claim. We offer a free case evaluation for claimants anywhere in the United States whose claims have been denied or terminated. Just give us a call to get started.