AETNA sued for failure to pay out disability benefits to ex senior nurse suffering from disabling mental conditions
On March 29th 2011, a lawsuit was filed against the AETNA Life Insurance Company (AETNA Life) at the District court for the Southern District of Florida. In the lawsuit, the plaintiff alleged that AETNA Life had refused to pay the disability benefits sought by the plaintiff under a group long term disability (LTD) benefits policy that was issued and administered by AETNA Life.
The Nature of the Complaint
The plaintiff was a Senior Emergency Room Registered Nurse employed by the University of Miami Hospital. As a result of his employment at the University of Miami Hospital, the plaintiff was a participant of a group insurance policy for LTD benefits that was issued and administered by AETNA Life. As a participant of the policy, the plaintiff was entitled to disability benefits in the event of him becoming disabled. Under the policy, “Disabled” was defined as:
From the day that you first become disabled and until Monthly Benefits are payable for 60 months, you will be deemed to be disabled on any day if:
- You are not able to perform the material duties of your own occupation (full time or part time) solely because of disease or injury and
- Your work earnings are 80% or less of your adjusted pre-disability earnings
After 60 months that any Monthly Benefits is payable during a period of disability, you will be deemed disabled on any day if you are not able to work at any reasonable occupation solely because of disease or injury.
The plaintiff as a result of suffering from several disabling conditions like obsessive compulsive disorder, bipolar disorder and psychotic hallucinations was prevented from performing the material duties as required under his occupation and any other reasonable occupation. Due to his inability to work, the plaintiff ceased working on November 24th 2008 and filed an AETNA disability claim.
As required under the policy, the plaintiff informed AETNA Life of his disabling conditions. Medical documentations relating to the plaintiff’s treatment was provided to AETNA Life to support the claim of being disabled. In addition, the plaintiff’s job description with the University of Miami Hospital was provided to AETNA Life. At the same time, the plaintiff’s attending physicians also consistently informed AETNA Life that the plaintiff is disabled as with the same conclusion drawn up by Social Security Administration. The Social Security Administration recognizing that the plaintiff was disabled, provided him with monthly Social Security Disability Income payments but made to a trusted individual due to the plaintiff’s mental health problems.
Despite the legitimacy of the plaintiff’s claim for disability benefits, AETNA Life on July 27th 2009 by way of correspondence denied the claim for disability benefits. According to AETNA Life, the “medical information received and reviewed failed to support functional impairments that would preclude [the plaintiff] from performing the essential job tasks of [his] occupation as a Senior Emergency Room Registered Nurse”.
Relief sought by the plaintiff under the lawsuit
Despite requesting a review of AETNA Life’s decision on January 25th 2010 and providing additional medical documentations from the plaintiff’s attending physicians and licensed therapists supporting the review, AETNA Life again denied the plaintiff’s claim for disability benefits on July 27th 2010. Exhausting all his administrative remedies with AETNA Life under the Employee Retirement Income Security Act (ERISA), the plaintiff has no recourse but to file a lawsuit against AETNA Life seeking:
- All the benefits that he is entitled to under the plan including of prejudgment interest retroactive to the day that the benefits were terminated;
- Reasonable attorney fees and costs as a result of pursuing this action against AETNA Life;
- Appropriate equitable relief which the court deem just and proper due to the act and omissions of AETNA Life.
Resources to Help You Win Disability Benefits
Submit a Strong Appeal Package
We work with you, your doctors, and other experts to submit a very strong appeal.
Sue Your Disability Insurance Company
We have filed thousands of disability denial lawsuits in federal Courts nationwide.
Get Your Disability Application Approved
Prevent a Disability Benefit Denial
Negotiate a Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Aetna STD has been a nightmare since the beginning
Reply
Aetna leaves me at risk of losing my job and without compension
Aetna puts their clients through hell with their games
Reply
It's been over 3 months, and I've only received one payment from Aetna
Reply
Aetna people are thieves, crooks and liars.
Aetna is definitely committing a crime and they need to be stopped.
Reply
I hate Aetna
Reply
Aetna denied me and then I got fired from my job
Reply
Q: Can Aetna deny my application on the basis of pre-exisiting condition? Do they discriminate against the mentally ill?
Q: Are there any circumstances in which I can appeal LTD after the number of days Aetna gives you to appeal?
Q: Can Aetna deny my claim due to a "war exclusion" on my policy?
Q: What do I do if Aetna claims they haven't received my medical info?
Q: How can Aetna say I am not disabled when clearly I am?
Q: Is the 2nd appeal process worth it or a waste of my time?
Q: What can I do to stop Aetna from harassing me and realize that not all disabilities are the same?
Q: Can Aetna deny my claim for STD due to pregnancy because it was preexisting?
Does Social Security Approval Mean Disability Insurance Benefits Will Be Paid?
Does a disability insurance company need to consider the side effects of my medications?
Does the Mental Nervous Disorder Limitation in an ERISA Long Term Disability Plan Violate ADA Laws?
Is it legal to limit disability insurance benefits to 24 months for mental nervous claims?
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
Aetna Overturns Denial of Long Term Disability Benefits for Quality Control Manager
Aetna Removes 24 Month Limitation for Mental Health Conditions
Aetna Overturns Denial of LTD for Former Employee of The Home Depot
Aetna Reinstates Benefits for Former SAP America Employee Suffering the Effects of a Head Injury
Aetna overturned previous denial of long term disability benefits for Georgia Assistant
Dell Disability Lawyers file Lawsuit in Federal Court against Aetna after it denied long-term disability benefits to former software Developer
After Aetna denied Ms. Garner's long-term disability claim, Ms. Garner filed suit against Aetna, and the Court overturned Aetna's decision and ordered it to pay Ms. Garner's disability benefits
Aetna Reinstates Disability Insurance Benefits to Home Depot Manager
Reviews from Our Clients






