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Leading Senate Democrats Follow California Inquiry; Colorado, Washington and Connecticut Also Looking Into Aetna’s Process of Claims Review

Thursday, June 14th, 2018

If you’re not already mad as hell about how decisions are made by disability and health insurance companies already, reading the deposition of Dr. Jay Iinuma, a medical director for Aetna Insurance, will certainly send you in that direction.

We are linking to this deposition here, because we believe that every person who has an Aetna long term disability insurance policy should have the opportunity to read Dr. Jay Iinuma’s deposition in the case of Washington v. Aetna. The more you know about how Aetna’s review and appeals process works, the better prepared you are for what may come once you file a claim for disability insurance benefits.

Basically, Dr. Iinuma pulls back the curtain of the processes as Aetna makes the coverage decisions that, in many cases, condemn people to financial hardship, limit their ability to receive the medical care they need, and in some cases, leads to serious outcomes when proper medical care is denied.

We have seen first-hand the effect of this process on our Aetna disability insurance clients. It’s infuriating, irresponsible and frankly, cruel.

Dr. Iinuma corrects the attorney deposing him to clarify something: that the nurse reviewed the medical records and gave him the lab work information required. He himself did not review the records medical records: “I’d look at what the nurse provided, the information that the nurse provided.”

When asked if there was information missing, and if he ever asked a nurse to provide the medical records, his answer was “No, I did not.”

Most of his work was looking at records online.

And very rarely did he even have a conversation with a nurse about a case – he himself describes this as “particularly rare.”

The conversation gets a little dicey when the doctor, who is by his own admission a family doctor, is asked about common variable immunodeficiency. He is not familiar with the treatments, symptoms or what happens when treatment stops. He had made decisions on this patient’s insurance coverage based on information from a nurse’s report.

Aetna responded with an article designed to appear like a news article on its own website that directly contradicts what Dr. Iinuma said in his deposition. A sworn statement appears on the website to support Aetna’s position.

The request for further information from two Senate Democrats and California, Colorado, Washington and Connecticut has not yet been reported on. When it is, we’ll update you here.

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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