Aetna

In Gregory Cannon v. Aetna, a pharmacist challenged Aetna’s denial of short-term disability benefits, arguing the insurer ignored his symptoms, failed to follow internal procedures, and overlooked his Social Security approval. The court sided with Aetna, finding no abuse of discretion and concluding Cannon failed to provide sufficient objective evidence of disability.

Plaintiff appealed the initial denial of benefits under the Plan, stating that her request for disability was not based solely on her thyroid surgery but rather on symptoms associated with lupus and chronic pain. On September 12, 2011, ALIC again upheld the denial of benefits to the Plaintiff. As allowed under ERISA, the Plaintiff sued to challenge that decision. Both parties moved for judgment on the administrative record.

Laverne Robinson, a former utility machine operator, sued Aetna Life Insurance Company after her benefits were terminated. Aetna argued Robinson hadn’t been approved for Social Security Disability within the Plan’s 24-month window for continued long-term disability (LTD) benefits — even though the SSA later retroactively awarded her SSDI for that same period. The court ruled …

After being approved for short-term disability, Cassidy applied for long-term disability benefits, citing chronic fatigue syndrome and fibromyalgia among several other diagnoses. Aetna denied the claim for lack of objective evidence that these conditions actually limited her ability to work, and the court agreed — holding that proving a diagnosis exists is not the same …

Mozdzierz sought long-term disability (LTD) benefits from Aetna under an ERISA-governed plan, but the court upheld Aetna’s denial, finding it did not abuse its discretion. The case is worth noting for the court’s discussion of video surveillance as investigatory evidence in long-term disability claims. Case at a Glance Insurer Win Case Steven Mozdzierz v. Aetna …

The Court granted Plaintiff’s Motion for Summary Judgment: “As explained above, I have identified three primary reasons for determining that Aetna abused its discretion in denying Plaintiff’s benefits: Inappropriate reliance on unreliable findings by Drs. Topper, McPhee, and Polanco; failure to address Plaintiff’s qualifications and ability to engage in sedentary occupations in light of her medication requirements; and failure to address the findings in the APS and Capabilities and Limitations Worksheets showing that Plaintiff could not perform full-time sedentary work.

Aetna Life Insurance Company (“Aetna”) terminated Patterson’s long-term disability (“LTD”) benefits after concluding he could perform “sedentary” work under a national-economy definition of his “own occupation” — without ever assessing whether he could perform his actual job duties for his employer. The Third Circuit affirmed summary judgment in Patterson’s favor, holding that “own occupation” unambiguously …

The medical evidence available does not suggest that Aetna abused its discretion by determining that Neno is able to perform the "material duties" of his "own occupation" as defined under the employee welfare benefit plan. Aetna's decision was supported by substantial evidence and was made with deliberate and principled reasoning, as it reviewed Neno's medical records and sought opinions from independent sources.

When considering the record as a whole, the Court finds that Aetna’s denial of LTD benefits to Murphy was supported by substantial evidence therein and that Murphy has not met her burden to establish that such denial was arbitrary and capricious. Accordingly, Murphy’s objections to Aetna’s denial cannot withstand Aetna’s motion for summary judgment.

Under the arbitrary and capricious standard, the review is limited to whether reasonable grounds existed to support Aetna’s denial of benefits based on the administrative record before it. The Court held that Aetna reasonably concluded that Plaintiff was no longer entitled to long-term disability benefits and that their decision process was neither arbitrary nor capricious. Aetna’s denial of continued long-term disability benefits was affirmed.

The Court found Aetna’s denial of Plaintiff’s claim for long-term disability to be arbitrary and capricious and ordered Aetna to pay the long-term disability benefits for which he is qualified under the Plan.

Aetna approved the Appellant’s claim for LTD benefits from September 25, 2012, through February 23, 2013, but denied her claim for benefits for any period thereafter. Thus, the Sixth Circuit limited its review to determining, de novo, whether the Appellant was entitled to benefits beyond February 23, 2013.

The Eighth Circuit affirmed that Lisa Jones was not entitled to long-term disability (LTD) benefits from Aetna Life Insurance Company and, in this later appeal following an earlier remand, affirmed dismissal of her related breach-of-fiduciary-duty claim because she never raised it during Aetna’s internal administrative appeal process. Case at a Glance Insurer Win Case Lisa …

Here, Aetna has engaged in multiple procedural irregularities, including conducting a self-serving paper review of the medical files based on the incorrect disability standard, relying on the opinion of a non-treating, non-examining physician without reason, and denying benefits based on inadequate information and lax investigatory procedures, as evidenced by Aetna’s decision not to pursue an independent medical examination and its failure to analyze the specific requirements of Plaintiffs own occupation. These irregularities compounded each other and lead the Court to find that Aetna acted arbitrarily and capriciously in denying Plaintiffs LTD benefits.

The problems in Aetna's review of Maiden's evidence—inexplicably disregarding the opinions of treating physicians and ignoring evidence supporting disability while cherry-picking evidence to support a denial—lend an unmistakable hue of capriciousness to Aetna's review.

A federal court in Pennsylvania granted summary judgment to Aetna Life Insurance Company, holding that its decision to deny Vanessa Pearson-Rhoads’s long-term disability claim was reasonable and not an abuse of discretion. Case at a Glance Insurer Win Case Vanessa Pearson-Rhoads v. Aetna Life Insurance Company Court United States District Court for the Eastern District …

A federal court in Maine granted summary judgment to Aetna Life Insurance Company, holding that its decision to deny Colon Carter’s long-term disability claim was reasonable and supported by sufficient evidence, despite Carter’s arguments that the reviewing physician had mischaracterized his treating providers’ findings. Case at a Glance Insurer Win Case Colon L. Carter v. …

A federal court in Missouri dismissed Tiffany Ausler’s lawsuit against Aetna Life Insurance Company, holding that her short-term disability claim was time-barred under the plan’s 180-day contractual limitations period and that she had failed to exhaust the plan’s required administrative process for her long-term disability claim, without reaching whether she was actually disabled. Case at …

A federal court in North Carolina granted summary judgment to Aetna Life Insurance Company, holding it did not abuse its discretion in denying Charles Arning’s long-term disability claim, given the absence of any significant change in his medical condition and video surveillance conflicting with his treating physician’s restrictions. Case at a Glance Insurer Win Case …

A federal court in Ohio granted summary judgment to Aetna Life Insurance Company and the Federal Express Corporation Short Term Disability Plan, holding that the denial of Christopher Draper’s short-term disability benefits was supported by a deliberate, principled reasoning process, even though Aetna’s review of his MRI results was not particularly detailed. Case at a …

Aetna’s decision to deny the plaintiff benefits was unsupported by substantial evidence and was, thereby arbitrary and capricious. Aetna gave great weight to the opinions of its own experts and afforded little, to no, weight to the plaintiff’s own physicians. Under the circumstances, the plaintiff’s physicians—who had been treating him for several years—would be better able to recommend health and safety conditions than doctors who simply reviewed his medical files.