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Court Determines Aetna Failed to Appropriately Consider Impact of Pain

Monday, November 26th, 2012

A Federal Judge has denied Aetna’s efforts to dismiss a challenge to its claim determination in a long term disability insurance claim, finding that Aetna failed to properly consider the functional limitations of an insured, whose long term disability insurance claim was terminated after being paid for several years under the policy.

Significant to the Court’s analysis was the failure of Aetna to make efforts to truly understand the impact of the claimant’s pain upon functionality. While noting that pain is often difficult to measure, the Court chastised Aetna, noting that simply because of such challenges, did not mean that claims of pain are simply false. The Court also noted that the Social Security Administrator had found the claimant’s pain complaints to be credible, as did his doctors. The Court was also troubled by Aetna’s failure to seek clarification from the claimant’s doctors, noting that rather than simply rejecting the impact of pain, it would have been more appropriate to seek additional information.

Debower v. Aetna

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This is about a Social Security Disability claim.

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