Court Throws Out Disability Benefit Denial Based on Aetna's Internal Physicians' Review
Insurance companies review the medical reasons underlying a disability benefit claim. Often, the reviewer is a doctor, nurse or economist employed on a full-time basis by the insurance company. Their job is to look for ways to deny your claim to maximize the insurance company’s profit. But keeping them honest can be difficult because their training and experience can create challenges for unsuspecting claimants or inexperienced disability benefit lawyers. That is why having an experienced Florida disability attorney is important.
Let’s examine a case against Aetna Life Insurance Company. The claimant was a computer programmer and research analyst for the University of Miami’s School of Medicine. He had long-term disability coverage under an ERISA benefit plan through the University. In August 2006, he was diagnosed with carpal tunnel syndrome and could not work. He filed for disability benefits with Aetna and his initial claim and Appeal were denied. After exhausting all options, he sued for disability benefits with Aetna, asserting the severe pain in his hands prevented him from working.
An Internal Review By Aetna Insurance Company
The claimant supplied a detailed summary of medical evidence to support his disability claim. The evidence, dating back ten years, included testimony from five separate treating physicians who agreed that the plaintiff suffered from carpal tunnel syndrome and could not perform his work as a computer programmer because of his disability. Aetna then had the claim file reviewed by two in-house physicians, who determined that no evidence of carpal tunnel syndrome existed by relying almost entirely on a diagnostic test for carpal tunnel syndrome that produced negative results.
But, as the reviewing physicians conceded, the diagnostic tests were known to report false negatives. Aetna relied on the opinions of the reviewing physicians to deny the claim again because, in its view, it was not clear whether he could not work. The insurance company contended it had the right to pick between the conflicting medical testimony. The plaintiff sued, arguing Aetna wrongfully denied his disability benefits.
Aetna Relied on an Unsupported Report to Deny Disability Insurance Claim
The federal court ruled against Aetna, criticizing the insurance company for disregarding the unanimous medical opinions of five treating physicians over a ten-year period in favor of two reviewing physicians who relied on questionable diagnostic testing. The court stated that “the only conceivable reason Aetna could have for crediting the opinions of the reviewing physicians over those of the treating physicians is that the two reviewing physicians’ opinions permitted Aetna to deny benefits.” This was not a permissible reason, and the court required that Aetna pay the benefits to the claimant.
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






