In the case of Darren Cohen v. Aetna Life Insurance Company (Aetna), Plaintiff Darren Cohen was employed by a computer data storage technology company, STEC, Inc. His occupation was that of a Computer Systems Engineer, which required him to sit at his computer for 6-8 hours every day.

In Rebecca McCook v. Aetna Life Insurance Company, the U.S. District Court for the Middle District of Florida accepted the Report and Recommendation (R & R) of the Magistrate Judge and determined that Plaintiff McCook was not entitled to disability benefits. The Court held that “Although McCook has provided evidence that Aetna could have awarded her long term disability benefits, she has failed to establish that Aetna’s denial was arbitrary and capricious.”

All too often an insured’s claim for short term disability benefits is approved by their disability insurance carrier only to have the subsequent claim for long term disability benefits, which uses the same medical information used to approve the short term disability claim, denied by the insurance company. It is frustrating, illogical and inherently wrong to say the least. Arrogantly, the disability insurance companies, typically “protected” by the auspices of ERISA and the insurance industry friendly arbitrary and capricious standard of review, argues that they provided a full and fair review of the claim and that it has done nothing wrong in denying the claim. However, every now and then common sense does prevail.
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In Lavery v. Restoration Hardware Long Term Disability Benefits Plan, 2018 WL 3733936 (D. Mass. August 6, 2018), Plaintiff John Lavery (“Lavery”) brought claims under the Employee Retirement Income Security Act (“ERISA”) against Defendants Restoration Hardware Long Term Disability Benefits Plan (“the Plan”) and Aetna Life Insurance Company (“Aetna”) over the denial of his claim for disability benefits.

Benefit Provisions

The Plan states that “Long Term Disability Coverage does not cover any disability that starts during the first 12 months” of coverage if it is “caused or contributed to by a ‘pre-existing condition.’” The Plan further states that “a disease or injury is a pre-existing condition if, during the three months before the date you last became covered: it was diagnosed or treated; or services were received for the disease or injury; or you took drugs or medicines prescribed or recommended by a physician for that condition.”
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In this video disability insurance lawyers Gregory Dell and Cesar Gavidia discuss the recent Hartford purchase of the Aetna Disability Insurance Company and what impact that may have on Amazon employees who file claims for long-term disability. They conclude that the claims review process will likely not change since both companies already do everything they can to avoid paying a claim.
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