A Federal Judge in Connecticut has ordered Aetna to trial on a denial of group long term disability insurance claim, under ERISA.
The Court denied the parties’ motions for summary judgment, and has stated that “A trial will be scheduled for the earliest date.”
The parties submitted competing reports from experts – Aetna relying upon a report from Coventry Health (a company it purchased) as its source of “independent” evidence, while the claimant submitted a report which addressed and rebutted the Coventry report, and supported why the claimant remained impaired.
The rationale behind the Court’s decision related to Aetna’s deficient vocational assessment – a common theme in Aetna claims.
The Court was troubled by the vocational assessment and the failures to properly consider the issues, instead of focusing upon functional capacity levels of sedentary or light or otherwise.
In seeking to decide the case, the Court employed the de novo standard of review, on the basis of findings of violations of ERISA and under Halo v Yale Health, which allowed the Court to modify the standard of review and implement a de novo review. However, even with the ability upon de novo review to reach these conclusions and determine eligibility, the Court still determined that material issues of fact prevented judgment at this time. The Court will surely be seeking to adjudicate the credibility of the witnesses who have authored the respective vocational reports.
One of the critical issues which remains open includes Aetna’s failure to assess the possibility of accommodations to engage in certain work.
As this case proceeds in the District of Connecticut, we will be eagerly watching, as a trial will require Aetna to expose issues concerning its claim handling and processes, and its clear anti-claimant bias will be readily revealed.
Schumjan v. Aetna Life Ins. Co.