Aetna disability insurance is intended to protect employees from a loss of income resulting from an inability to work due to an accident, illness, or injury. If you cannot work you can file a disability claim, and you may receive short term disability (STD) benefits after a short waiting period (typically referred to as an “elimination period”). If you are still unable to return to work at the end of the STD benefit period then you may be eligible for Aetna long term disability (LTD) benefits.
Unfortunately, insurance companies such as Aetna do not always live up to their end of the bargain. All too often we hear from policyholders who have received Aetna disability denials rather than the monthly long term disability benefits they were counting on. If your claim has been wrongfully denied or terminated the Aetna long term disability lawyers at Ortiz Law Firm will fight to obtain the benefits you are entitled to under the terms of your disability policy.
Top Reasons Aetna Denies Long Term Disability Insurance Claims
Sometimes disability insurance companies like Aetna do not pay benefits as they should. They will look for ways to use the terms and policy provisions, such as the definition of disability, to deny your claim. In this video, Nick Ortiz explains the top 5 reasons a claimant will receive an Aetna disability denial. The key points of the video are also summarized below:
The Definition of Disability
One of the top reasons for an Aetna disability denial is a change in the definition of disability. Many disability insurance policies have a definition of disability that changes after a certain period of time, typically after the first 24 months. During the first 24 months, you will have to prove that you are unable to perform your own occupation. After 24 months, you will have to prove that you are unable to perform any occupation.
Each policy has a different definition of disability, so you’ll need to review how this term is defined in your policy. In fact, many important terms and policy provisions that will impact your disability case vary between different disability insurance policies, so it is important that you obtain a copy of your policy from the insurance company and review it carefully.
Aetna could also terminate your claim due to medical improvement. The insurer may find that your condition has improved enough for your to return to work and deny future long term disability benefits.
Insufficient Medical Evidence
Another reason for an Aetna disability denial is insufficient medical evidence. A letter from your doctor stating that you are unable to work is not sufficient. You will need to submit evidence to support your symptoms and resulting limitations. Aetna is one of many insurance companies that has gained a reputation for denying initial applications/claims by claiming it was missing information or documentation.
Using Your Own Doctors Against You
Aetna could also use your doctors against you to deny your long term disability insurance claim. Aetna will ask your doctors to fill out paperwork, and may even attempt to discuss your claim over the phone. It is possible that your doctor could misunderstand the paperwork, or a statement given over the phone could be misinterpreted by the insurance carrier.
Another tactic Aetna uses to deny long term disability insurance claims is conducting surveillance. Aetna may hire a private investigator to conduct video surveillance of your activities. If Aetna determines that your activities are inconsistent with the limitations you have stated in support of your disability claim your claim will likely be denied.
At the end of the day, the insurance company exists to make money. They do so by collecting more in premiums than they pay out in benefits. The fewer payouts they make on claims, the more profits the insurance companies keep for shareholders. If you understand this basic premise, you will have a greater understanding of why even the best-prepared disability claims can be denied. It is not personal to you.
Filing a Successful Appeal When Your Aetna Disability Claim Has Been Denied
If you receive a denial letter in response to your application, or if your benefits are terminated prematurely, do not despair and give up. If your claim was denied you have the right to file an appeal directly with Aetna’s internal appeals review process. You may even have the right to submit more than one appeal to the insurance company. After you have “exhausted” your appeals, you have the right to file an ERISA lawsuit.
Note: if you have an individual disability insurance policy you purchased on your own (outside of a group disability plan), or if you are a government employee or member of a church plan, you may be exempt from ERISA disability law and have the right to file your lawsuit in state court, which affords greater protections in disability claims to you the consumer than an ERISA claim in federal court. This is why it is important to hire a lawyer to explain your legal options to you. Most disability attorneys offer a free consultation.
Mr. Ortiz and his experienced legal team offer detailed advice to disabled individuals throughout the administrative appeal and litigation process, and will help you:
- Understand the reasoning behind your Aetna disability claim denials;
- Acquire additional medical records and evidence to file with the appeal;
- Obtain opinions from your treating doctors with respect to your impairments resulting from your injury or illness;
- Complete the appeals paperwork;
- File your appeal within the required time limits;
- File an ERISA lawsuit in federal court or a breach of contract lawsuit in state court; and
- Prepare your case for trial.
If you have received a denial do not hesitate to call us to get professional help from a lawyer. While there are no guarantees that the appeal of your long term disability insurance claim denial will be approved on the first try, we will work diligently to help you file a claim that is clear and concise, and complete with all necessary information.
Hire a Long Term Disability Attorney
As stated above, many individuals who file for disability insurance benefits are shocked and dismayed by the hurdles placed in front of them by Aetna during the disability claim process. Aetna requests more and more paperwork as part of the “proof of loss”.
Just when you think you’ve filled out the last form, you are given yet another one to fill out. Your doctor may begin to get annoyed with Aetna’s phone calls to the doctor’s office and numerous requests for the doctor to also fill out paperwork. Then, after the claim is finally finished, your claim is denied by Aetna and you receive a disability denial letter in the mail.
Policyholders reach out to us very upset that they have been denied the very disability insurance benefits they thought would be there to protect them should they ever lose their ability to work due to a disability. Most are upset or downright angry at Aetna for its delays and denials. That’s why it is important to have an experienced Aetna disability attorney assist you in explaining to you the reasons for the insurance company’s disability denial, and what you can do to fight back and win your disability insurance claim.
At the Ortiz Law Firm, we know how difficult it can be to deal with all the paperwork associated with filing a disability insurance claim and proving your loss. You have enough to deal with in treating your injury or illness. We also know how important these disability insurance payments are to you and your family when you cannot work and earn an income.
Let us take on the burden of fighting the insurance company. With more than a decade of experience in dealing with insurance companies and disability insurance policies, our Aetna long term disability lawyer has the skills and knowledge needed to help you understand your rights under your policy in order to pursue the benefits you deserve.
We Fight Aetna Disability Denials
Many disability insurance claims are denied, or your claim may initially be approved and then cut off prematurely. That’s when the Ortiz Law Firm can be of assistance. We are a disability law firm that represents individuals whose disability insurance claims have been wrongfully denied or terminated.
If you have received a disability denial letter from Aetna, make sure that you call us as soon as possible to schedule a free consultation with an experienced disability attorney. Disability claim denials are not the end of the process. Our disability attorneys are experts in disability law and will fight to obtain the long term disability benefits you deserve from Aetna.
Working with an experienced disability lawyer can be the difference between winning and losing your claim for disability with the disability insurance company. We also handle Social Security Disability claims, and most insurance carriers will require you to apply for Social Security Disability, so we can assist you with both of your disability claims.
If your Aetna insurance claim has been denied or terminated then we can help. Our firm has represented numerous clients in claims against Aetna for disability insurance coverage. We may not be one of the largest firms, but we have years of experience representing disability applicants who have had their claims denied or terminated.
Call us at (888) 321-8131 to request a free consultation to discuss your individual Aetna disability claim. We offer a free legal consultation for claimants anywhere in the United States whose claims were denied or terminated. Just call us to get started.