Articles Tagged with Aetna

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Schizophrenia.

According to the National Institute of Mental Health[1], schizophrenia is described as follows:

Schizophrenia is a chronic and severe disorder that affects how a person thinks, feels, and acts. Although schizophrenia is not as common as other mental disorders, it can be very disabling. Approximately 7 or 8 individuals out of 1,000 will have schizophrenia in their lifetime.

O’Ryan Law Firm, on behalf of Plaintiff, Kimberly G., recently filed a federal lawsuit against Aetna Life Insurance Company (“Aetna”).   Plaintiff was employed by Amazon Corporation, as a warehouse worker, which made her eligible for Amazon’s employee benefit plan.  Aetna issued the disability policy that provides long term disability benefits to Amazon employees who are unable to return to work due to a serious illness or injury.

Facts of the Case Against Aetna

Plaintiff was employed by Amazon from July 2012 until she became disabled in July 2016.  Plaintiff was unable to work due to significant bladder issues, including incontinence, due mainly to a surgical procedure that compromised her bladder. The Plaintiff’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these ailments.

Many Indiana employees receive group disability insurance coverage through Aetna. Headquartered in Hartford, Connecticut, Aetna is a large disability insurance company that is currently in the Fortune 100. O’Ryan Law Firm has successfully represented many clients whose disability insurance benefits have been unfairly denied or terminated by Aetna.

Short Term Disability Benefits

Aetna’s short term disability coverage pays benefits after a short elimination period (often a week long). Short term disability benefits usually last three to six months. During Aetna’s investigation of the short term disability claim, it is common for Aetna to gather medical records, gather information about the claimant’s job, require statements from treating providers about the claimant’s ability to work and expected duration of disability, and have internal medical consultants review all medical evidence. If the individual is approved for short term disability benefits through the maximum duration of the policy, then they may apply for long term disability benefits.

Long Term Disability Benefits

After an elimination period that is typically the length of the short term disability period, the claimant may apply to Aetna for long term disability benefits. When a claimant receives long term disability insurance through a private employer, their claim is usually governed by the Employee Retirement Income Security Act (“ERISA”).

In addition to information already gathered during the short term disability claim, Aetna will request updated medical records and statements from treating providers, may perform a vocational analysis, and may have internal medical consultants or external medical consultants review the medical evidence. It is very common for long term disability policies to require that the claimant prove disability from their own occupation for the first 24 months of long term disability benefits and then require that the claimant prove disability from any occupation after 24 months of long term disability benefits.

During the long term disability claim, it is more common for Aetna to utilize claim review tactics such as referring the claimant for an Independent Medical Examination (“IME”), contracting private investigators to perform surveillance of the claimant, contracting peer reviewing physicians to review evidence and call the claimant’s doctors, and perform a Transferable Skills Analysis to see if the claimant can return to work in a different job. If a claimant is approved for long term disability benefits, it is likely that Aetna will urge the claimant to apply for Social Security disability benefits. Aetna may even refer the claimant to one of its vendors to represent them in their Social Security disability claim.
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