Aetna fails to review Bank Of America employee's ERISA disability benefit appeal timely resulting in lawsuit by an Illinois disability lawyer
Brian Woulfe of northern Illinois worked as a mortgage loan officer for Bank of America until he was no longer able to work with reasonable continuity because of complications that arose from being treated for non-Hodgkin’s lymphoma.
The exact nature of Mr. Woulfe’s non-Hodgkin’s lymphoma isn’t specifically stated within the civil complaint he and his disability attorney filed against Aetna Life Insurance Company (Aetna) and Bank of America Group Benefits Program. However, people suffering from non-Hodgkin’s lymphoma usually present symptoms such as:
- swollen lymph nodes in the armpit, groin, or neck
- pain or swelling in the abdomen
- night sweats
- fever
- fatigue
- unexplained weight loss
Non-Hodgkin’s lymphoma occurs when a certain type of blood cell known as a lymphocyte does not go through a normal life cycle by dying when new lymphocytes are created. Instead, these abnormal lymphocytes continue to divide, grow, and spread throughout your lymph nodes and possibly into other organs of your body.
Depending upon the severity of a person’s non-Hodgkin’s lymphoma, chemotherapy or radiation therapy may be necessary. These aggressive forms of treatment can take quite a physical toll on a person’s body.
Mr. Woulfe’s last day of being able to work was July 2, 2009. Seven days later, Mr. Woulfe filed for short-term disability benefits with Aetna. Aetna approved his short-term disability benefits claim and paid him through December 30, 2009.
Aetna notified Mr. Woulfe on April 23, 2010 that the period for receiving short-term benefits has expired and they would evaluate his claim for long-term disability benefit payments. Aetna informed Mr. Woulfe on June 16, 2010 that his claim for long-term disability benefits had been denied effective December 31, 2009.
Since Mr. Woulfe submitted what seemed to be more than adequate documentation that would substantiate a long-term disability benefit claim that would precipitate an appeal, Mr. Wolf retained a disability insurance lawyer to help guide him through the appeals process. Therefore, on November 29, 2010, Mr. Woulfe appealed Aetna’s decision to deny long-term disability benefit payments to him.
Aetna responded to Mr. Woulfe’s appeal stating they would get back to him within 45 days from the day they received Mr. Woulfe’s appeal – December 1, 2010. That would mean Aetna had until approximately January 15, 2011 to respond to Mr. Woulfe’s appeal. However, Aetna requested an additional 45 days since special circumstances warranted more time for them to deliberate Mr. Woulfe’s appeal. That meant Aetna should have a decision made regarding Mr. Woulfe’s appeal for long-term disability benefit payments by no later than March 1, 2011.
Aetna’s appeal team informed Mr. Woulfe on January 21, 2011 that Aetna’s original decision to deny him long-term disability benefit payments was overturned. The matter now rested with Aetna’s operations team for them to review Mr. Woulfe’s claim for disability benefits.
Apparently, Aetna’s operations team received the appeal team’s decision to overturn Aetna’s original decision to deny Mr. Woulfe’s long-term disability benefit claim on February 4, 2011. Aetna’s operations team told Mr. Woulfe they would have a decision made within 30 days. However, as of March 4, 2011 Aetna had not yet made a decision with respect to Mr. Woulfe’s long-term disability benefit claim. In fact, they notified Mr. Woulfe that their decision is forthcoming and would be issued “no later than April 4, 2011.”
Mr. Woulfe’s disability lawyer informed Aetna on March 14, 2011 that his client had been approved by the Social Security Administration to receive Social Security Disability Income benefit payments dating back to July, 2009. Mr. Woulfe’s disability lawyer also reminded Aetna of their intent to render a decision within 90 days of receiving Mr. Woulfe’s appeal. Acting on Mr. Woulfe’s behalf, his disability lawyer also demanded a check from Aetna that would cover “all accrued LTD benefits was expected by the end of the week.”
Aetna responded on April 4, 2011 saying they had not yet reached a decision, but would notify Mr. Woulfe of decision regarding his appeal no later than May 1, 2011.
In response to Aetna’s apparent delay tactics, Mr. Woulfe’s disability attorney informed Aetna they had one more week as of April 8, 2011 to come up with a decision regarding his clients long-term disability benefit claim before his client would file a lawsuit against them.
Being that there was no further communication from Aetna, Mr. Woulfe and his Illinois disability lawyer filed an ERISA lawsuit in United States District Court for the Northern District of Illinois in the Eastern Division for Aetna’s denial of long-term disability benefit payments to Mr. Woulfe.
Mr. Woulfe is seeking payment for:
- long-term disability benefits dating back to December 31, 2009;
- prejudgment interest of 9% per year on all accrued benefits that have accumulated prior to the court handing down its decision;
- long-term disability benefits for the time during which he is “disabled” according to the long-term disability benefit plan;
- attorney’s fees and court costs.
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