Hi, my name is Nick Ortiz. I’m a board certified disability insurance attorney. Today I’m here to talk to you about Aetna Life Insurance Company and how they handle long-term disability claims.You may be here because Aetna has denied your LTD claim. Aetna denies claims for a number of reasons and today I am going to go over the top five.
Number one, they may deny your claim because there has been a transition in the definition of disability after 24 months. What that means is for the first 24 months of your policy they will typically pay benefits so long as you can not perform the material duties of your job. We call that OwnOc, your own occupation. After 24 months then they will pay benefits so long as you can not perform the material duties of any job. Or what we call AnyOc, any occupation. It is usually after this 24 month period that they say, look we know you couldn’t perform the material duties of your job, but we think there’s other work you can do. So they cut you off from your benefits at the two year mark.
The second reason why they deny claims is because they find that there has been medical improvement. What that means is they feel like you were entitled to benefits for a while, but your medical problems improved quite a bit, to the point where you could probably go back to work. And that is a basis for cutting you off of benefits.
A third reason is just they say there is insufficient medical evidence. Maybe you stopped going to the doctor and they say that they don’t think the medical evidence supports the fact that you are eligible for benefits anymore.
A fourth reason is that they may be using your own doctors against you. They may have sent some forms to your doctors to fill out and your doctors really didn’t fill them out very well, or maybe they didn’t understand the forms, and Aetna is actually going to use your own doctors against you and deny your claim.
And a fifth reason is, they may have even conducted covert surveillance. What that means is, they may have hired a private investigator to follow you around and record video evidence of your condition. And they say upon review of that evidence, that they think you could actually do some work because the video shows that you are a little bit more active than you claim to be.
There may be other reasons why Aetna denies your claim, but if you’d like to discuss your legal rights, in terms of what you can do to fight back against Aetna, when they have either denied your claim or terminated your benefits, then give us a call at 850-898-9904 and we can discuss what we can do to assist you in appealing your decision.
Otherwise, if you’d like some free information before calling, then I encourage you to download an e-copy of a book that I wrote called “The Top 10 Mistakes That Will Destroy Your Long Term Disability Claim”. You can download that book at www.freeltdbook.com We look forward to hearing from you