The Court found Aetna’s denial of Plaintiff’s claim for long-term disability to be arbitrary and capricious and ordered Aetna to pay the long-term disability benefits for which he is qualified under the Plan.
Aetna
McKenna v. Aetna – Court Gives Little Weight To The Opinion Of Non-Examining Physician
Aetna approved the Appellant’s claim for LTD benefits from September 25, 2012, through February 23, 2013, but denied her claim for benefits for any period thereafter. Thus, the Sixth Circuit limited its review to determining, de novo, whether the Appellant was entitled to benefits beyond February 23, 2013.
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Kochanek v. Aetna – Court Upholds Decision To Deny LTD Claim Due To Lack Of Medical Evidence
Katherine Kochanek (“Kochanek”) worked as an employee of Home Depot U.S.A., Inc. (“Home Depot”). Through her employment, she was covered by the Home Depot Welfare Benefits Plan which included short-term disability benefits. Aetna Life Insurance Co. (“Aetna”) served as the administrator of the Plan. Under the Plan, a “disability” is considered to be any pregnancy-related …
Jones v. Aetna – Court Finds Breach Of Fiduciary Duty Claim Is Not Duplicative
Lisa Jones submitted a claim for long-term disability benefits under an LTD Plan provided to her by Boeing. Aetna was the plan administrator; Aetna denied the LTD claim. Ms. Jones sued under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The district court (lower court) dismissed the …
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Granville v. Aetna – Aetna’s LTD Denial Was Arbitrary And Capricious
Here, Aetna has engaged in multiple procedural irregularities, including conducting a self-serving paper review of the medical files based on the incorrect disability standard, relying on the opinion of a non-treating, non-examining physician without reason, and denying benefits based on inadequate information and lax investigatory procedures, as evidenced by Aetna’s decision not to pursue an independent medical examination and its failure to analyze the specific requirements of Plaintiffs own occupation. These irregularities compounded each other and lead the Court to find that Aetna acted arbitrarily and capriciously in denying Plaintiffs LTD benefits.
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Maiden v. Aetna – Experts’ Bread Has Been Buttered By Aetna Before
The problems in Aetna’s review of Maiden’s evidence—inexplicably disregarding the opinions of treating physicians and ignoring evidence supporting disability while cherry-picking evidence to support a denial—lend an unmistakable hue of capriciousness to Aetna’s review.
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Pearson-Rhoads v. Aetna – Court Rejects Treating Physician’s Opinion In Favor Of Paper Review
In Pearson-Rhoads v. Aetna Life Insurance Company, the plaintiff sued for the payment of long-term disability insurance benefits from the insurer of her ERISA governed plan, Aetna Life Insurance Company. The plaintiff made numerous arguments. All were rejected by the court. Of particular note here is the plaintiff’s argument that Aetna abused its discretion by …
Carter v. Aetna – Court Rules Plaintiff Did Not Meet Burden Of Proof
Colon Carter (“Carter”) worked as an estimating analyst for Bath Iron Works (“BIW”), a subsidiary of General Dynamics. His job duties included “developing cost proposals for new Navy and commercial work; developing and maintaining proposal support documents and checklists; creating financial models; maintaining company baselines for all Programs; assisting management with department staffing plans; and …
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Hounihan v. Aetna – Court Rules Claimant Is Not Totally Disabled
Charlie Craig Hounihan (“Hounihan”) was a technician who was employed by Proctor and Gamble (“P&G”) on the Bounty paper towel line at a plant in Cape Girardeau, Missouri. Through his employment with P&G, Hounihan was covered under both short and long-term disability benefit plans with Aetna. The Proctor & Gamble Disability Committee (“Disability Committee”) is …
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Ausler v. Aetna – Court Reaffirms That Plaintiffs Must Exhaust Remedies To Bring Suit
In this case, Tiffany Ausler (“Ausler”) worked as a software engineer for Boeing Corporation (“Boeing”). Because she was a Boeing employee, Ausler was covered under both short and long-term disability compensation plans where Aetna Life Insurance Company (“Aetna”) was the administrator of the plans. The plan brochure explains that an employee may be eligible for short-term disability benefits …
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