LONG TERM DISABILITY BENEFITS DENIED BY AETNA – SUCCESSFUL APPEAL
Monday, June 28th, 2010
One of the elements of a successful long term disability claim is the ability to demonstrate regular medical care and a treatment regimen consistent with the disability. When examining a claim, long term disability insurance companies will look for a series of office visits, related tests, medications, and a treatment protocol that is consistent with the disability.
But not every patient follows the typical pattern of medical care and treatments, and this does not make them any less disabled. This is particularly so where the claim is predicated upon a mental or nervous condition or one involving the use of alcohol or drugs.
This was the situation faced by a high earning financial executive who came to us after his long term disability insurance claim was denied by Aetna. He was not able to work due to anxiety/depression and alcohol abuse. Aetna claimed that he was not disabled, since he was not under the regular care of his doctor. He was seeing a number of providers however, and we needed to piece together the treatment by multiple providers.
We secured his benefits by demonstrating that he was in fact maintaining continuity of care and seeing medical providers with enough regularity to satisfy the requirements of the policy. We argued that the decision Aetna had made had less to do with our client’s treatment and more to do with the high value of his claim. The decision, like so many others that we see, was the result of an insurance company making a decision that was a result of a conflict of interest, acting in its own favor rather than that of the claimant.
Our client is now back on claim and is receiving monthly benefits.
If this sounds like your situation, call our offices today and learn how we can help.