Disability Insurance Blog

Aetna Abuses Its Discretion on Long Term Disability Claim, Claim Gets Paid

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Thursday, May 23rd, 2013

Aetna has once again been found to have abused its discretion in the handling of a long term disability insurance claim, with a Federal Judge determining that Aetna’s claim decision was not reasoned, nor based on substantial evidence. The claim was based upon a mental health impairment, and the long term disability insurance claimant was suffering from anxiety.

Swaying the Court’s determination was the fact that Aetna chose not to undertake an actual examination of the long term disability claimant, but instead conducted a paper only medical review, and disregarded the subjective evidence put forth by the claimant, as well as the disregard of the opinions of the claimant’s treating psychiatrist and therapist. Courts have tended to find problematic the use of paper reviewing doctors, who do not conduct any actual examination, in psychiatric disability claims. Some courts have found that such conduct is actually unethical, while others simply hold that it is a factor lending support for a determination of arbitrary and capricious conduct.

As a result of Aetna’s conduct, the Court awarded the claimant her past due benefits, interest on the delayed benefits, and was willing to consider an award of attorneys fees.

Kuntz v. Aetna