Many companies offer their employees long-term disability insurance, but there is also the potential for those same employees being denied coverage when they need it the most. No matter how many pages of medical reports your personal physical may present, if a doctor contracted by the insurer offers a different opinion, it is unlikely a claim will be approved. In fact, this is exactly what happened in two different disability insurance cases involving Aetna Life Insurance Company.

Case 1: Tammy Smith vs. Aetna Life Insurance Company- Aetna Denies Disability Application Despite Severe Injuries Sustained in Auto Accident and Approval of Disability Benefits by Social Security

Plaintiff was employed by Bank of America as a mortgage loan officer and research analyst for nine years when she was involved in an auto accident on January 29, 2009. Back, spine, pelvic and hip injuries resulted in her doctors determining she was unable to work, so she applied for long-term disability under Bank of America’s contract with Aetna Life Insurance Company. Aetna denied both the plaintiff’s initial disability application and her ERISA appeal in spite of the fact that she met all of the necessary criteria for disability according to her doctors. Additionally, the Plaintiff was approved for Social Security Disability Benefits. At the recommendation of her California disability lawyer, plaintiff filed a lawsuit in United States District Court, Northern California Division.

Terms of the Lawsuit Against Aetna For Denial of Her Disability Benefit Application

Plaintiff is requesting judgment against the defendant under the following conditions:

  • Compensation for actual damages
  • Actual costs incurred filing the lawsuit
  • Attorney fees
  • Prejudgment interest on all benefits the defendant should have paid the plaintiff
  • Any other monetary compensation the court feels appropriate

Case 2: Paul Feickert vs. Aetna Life Insurance Company – Aetna ignores Social Security Disability Finding of Total Disability and Denies Benefits

The plaintiff was employed as a transportation security manager for the Transportation Security Administration where he was covered for long-term disability under a disability benefit plan. As a government employee the claimant’s disability claim should not be governed by ERISA. He was continually covered prior to the time he filed for disability payments in January 2008 after experiencing severe headaches since July 2007. The plaintiff was deemed disabled and submitted an application for disability benefits, a claim that was denied by Aetna on April 28, 2008. The plaintiff hired a Michigan disability attorney and filed an administrative ERISA appeal that Aetna also denied on December 11, 2008.

The plaintiff underwent several different medical and surgical procedures in an effort to alleviate the ongoing headaches with no results. The plaintiff’s attorney requested another review of the case on December 3, 2010, but on April 11, 2011 they made a final denial based on an evaluation by an independent physician. This was after the plaintiff was awarded Social Security Disability benefits on June 16, 2010 retroactive to January 3, 2008.

Terms of the Lawsuit Against Aetna

Because the plaintiff was wrongfully denied disability benefits, his attorney filed a lawsuit in the United States District Court, Western District of Michigan, Southern Division. Under the terms of the lawsuit, the plaintiff is asking for the following under a Prayer for Relief:

  • Judgment against the defendant is entitled to disability benefits and admission they made an error in judgment when denying benefits to the plaintiff.
  • A full accounting by defendants of all amounts due and payable to the plaintiff so he can ascertain he is receiving everything to which he is entitled.
  • Order that compels the defendant to pay all past and future payments that are due to the plaintiff.
  • Attorney fees and court costs.
  • Any other amounts the court may feel justified in awarding in this case.