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Court Determines Long Term Disability Insurance Claimant Entitled to Benefits

Thursday, February 14th, 2013

A Federal court in Oregon has determined that a claimant on long term disability should have her LTD benefits reinstated, which were wrongfully terminated by Aetna. The claimant, who worked directly for the Assistant General Counsel for Boeing, submitted a claim in 2009, which was initially accepted by Aetna, as claim administrator, and paid by Boeing.

The claimant had a long history of orthopedic problems in her spine, and had multiple surgeries in an effort to secure relief from her difficulties. She was disabled due to the functional limitations of her orthopedic problems, as well as the chronic pain, for which she took considerable pain medications. Her treating doctor provided objective evidence to support her impairment and demonstrated that she was functionally unable to engage in her work.

The Court was troubled by Aetna’s failure to afford meaningful consideration to the claimant’s treating providers’ opinions, noting that a “treating physician has a greater opportunity to know and observe the patient than a physician retained by the plan administrator.” The Court found that both of Aetna’s hired doctors’ opinions were misplaced, and not supported by the record. The Court also found that failing to seek an actual examination of the claimant, in favor of mere record reviews, was a factor to be considered in assessing whether the decision was the product of a deliberate, reasoned process.

Finally, the Court took note of two additional factors. First, the absence of any vocational consideration conducted was troubling, and second, the failure to consider the claimant’s award of Social Security Disability benefits.

The Court thus awarded the claimant past due benefits, and remanded the case back to Aetna for consideration of future entitlement to benefits.

Arnsperger v. Aetna

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