Our client suffered from vaginal mesh complications from an implant which left her totally disabled. We filed an appeal on her behalf when her Aetna long term disability insurance benefits were terminated. Initially, Aetna paid benefits for about eighteen (18) months but then determined she could return to work.
As a result of the vaginal mesh complications, our client suffered from a number of physical impairments and secondary mental health issues. She underwent multiple surgeries in an effort to alleviate the pain she suffered, but none worked. She was also on a cocktail of pain medications to help reduce the symptoms. Since the surgical interventions and pain medication did not help her, she ultimately had to stop working.
After her initial claim, Aetna acknowledged her total disability and began paying her long term disability benefits. However, they later determined that she could return the workforce. In the decision to terminate, Aetna failed to cite any improvement in her medical condition. They also failed to conduct a physical medical review and relied on the opinion of a behavioral health consultant. Lastly, Aetna failed to take into consideration the overall effect of all of her medical complications and conditions. Her treating physician has continuously stated that she is incapable of performing a sedentary occupation based on the severity of her condition.
In our appeal letter, we argued that Aetna’s failure to consider all of her medical conditions goes against the law. We cited a number of cases that hold it is the insurance company’s responsibility to look at all medical conditions together when conducting a review of a claim.
Additionally, we provided all of our clients medical records, progress notes, and test results that showed she was not only not improving, but was getting worse. The evidence showed that she was totally disabled due to the vaginal mesh complications and unable to work in any occupation.
Aetna reviewed our appeal and reversed the termination of benefits. Our client is now receiving the long term disability benefits she is due.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.
