Disability insurance protects employees from the loss of income resulting from an inability to work due to an accident injury or illness. You receive short term disability benefits after a short waiting period (typically referred to as an “elimination period”) of 0, 7, 14 or 30 days, and the benefits are payable for a specific duration (most commonly 3, 6, 12 or 24 months). Long term disability benefits are usually payable at the end of the STD benefit period. Thus, LTD benefits typically start three to six months after you become unable to work.
Sometimes disability insurance companies like Aetna do not pay benefits as they should. That’s where the Ortiz Law Firm can be of legal assistance. The Ortiz Law Firm represents employees and individuals when their disability insurance claims have been wrongfully denied, delayed, or terminated.
Aetna Disability Insurance
Aetna’s own website says it offers disability insurance as a way of “Protecting members when they’re unable to work.” Aetna states, “Our plans allow members to have income protection when they need it and help them get back to work as soon as it’s medically safe to do so.”
Unfortunately, Aetna does not always live up to its end of the bargain. All too often we hear from Aetna policyholders whose STD or LTD claims have been wrongfully denied, delayed or terminated (cut-off).
Aetna Long Term Disability Attorney
As stated above, many individuals who file for long term disability benefits are shocked and dismayed with the hurdles placed in front of them by Aetna in filing the claim. 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, Aetna denies the claim. Aetna has gained a reputation for denying initial applications/claims by claiming it was missing information or documentation. Policyholders call us very upset when they are denied the very benefits they thought would be there to protect them when they became unable to work due to an injury or illness. Most are upset or downright angry at Aetna for its delays and denials. That’s why it is important to have an experienced long term disability attorney assist you in explaining to you the reasons for the insurance company’s denial, and what you can do to fight back and win your claim.
At the Ortiz Law Firm, we know how difficult it can be to deal with all the paperwork associated with filing a long term disability claim and proving the loss. You have enough to deal with in treating your injury or illness. We also know how important these benefits are to you and your family when you are unable to 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, 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.
Filing a Successful Appeal When Your Aetna LTD Claim Has Been Denied
In the end, insurance companies exist to make money. They do so by collecting more in premiums than they payout in benefits. The fewer payouts they make on claims, the more profits they 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. If you receive a denial letter in response to your application for benefits, do not despair and give up. You have the right to file on ore more appeals directly with Aetna through its internal appeals review process. After you have “exhausted” your appeals, you have the right to file an ERISA lawsuit.
Note: if you have an individual policy you purchased on your own (outside of a group plan), or if you are a government employee or member of a church plan, you may be exempt from ERISA regulations 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 an attorney to explain your legal options to you.
Mr. Ortiz and his staff offers detailed advice to his clients throughout the appeals process, and will help you:
- Understand the reasoning behind your long term disability claim denial;
- 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 LTD claim appeal within the required time limits;
- Filing an ERISA lawsuit in federal court or a breach of contract lawsuit in state court; and
- Prepare your case for trial.
While there are no guarantees that the appeal of your claim 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.
Mr. Ortiz has represented several clients in claims against Aetna for long term disability insurance coverage, and he has lots of experience in representing disability applicants who have had their claims denied, delayed or terminated. Contact our office online or call 850-308-7833 to schedule a free case evaluation to discuss your individual Aetna LTD claim.