A federal court found Aetna wrong to terminate a former senior account executive’s long-term disability (“LTD”) benefits after paying such benefits for 14 years.
Background
Ms. Skinder began working for FedEx in October of 1998 as a senior account executive. Back surgeries forced Ms. Skinder out of work in 2001. Unable to work, she filed a claim for LTD benefits with Aetna. Her benefits were initially approved by Aetna. But, after two years of receiving disability payments, Aetna terminated her benefits stating he could work in any job for a minimum of 25 hours as required by the policy.
Aetna asked that Ms. Skinder attend a functional capacity evaluation (“FCE”). The results showed she was not capable of working in any capacity. Thus, Aetna reinstated her LTD benefits and continued to pay such benefits for 14 years through September of 2018. Aetna then terminated her benefits and denied subsequent appeals. Ms. Skinder filed a lawsuit in federal court for her benefits.
The Court’s Review of Ms. Skinder’s Claim
The court ultimately ruled for Ms. Skinder and had a great grasp of the case. The court found that Aetna had abused its discretion in terminating Ms. Skinder’s benefits for two main reasons:
- Aetna failed to consider evidence and allow Plaintiff to respond to evidence.
The court recognized Aetna did not give Ms. Skinder a full and fair review as required by the law. Specifically, Aetna did not take into consideration Ms. Skinder’s treating doctor’s letter supporting disability which was submitted as part of her appeal of Aetna’s termination of benefits. The court stated that this failure to consider supportive evidence was unlawful.
The court also remarked that Aetna was unreasonable in refusing to allow Ms. Skinder to respond to three separate medical reviews completed by Aetna’s doctors in response to Ms. Skinder’s appeal for benefits. This too was deemed unlawful.
- Aetna’s decision was not the result of a deliberate, principled reasoning process nor supported by substantial evidence.
The court noted that having received benefits for so many years, Ms. Skinder has proved her eligibility to receive such benefits. Aetna was wrong to terminate benefits without sending her for an examination as it had initially done with the FCE. Additionally, Aetna had a duty to inform Ms. Skinder was evidence it needed before terminating her benefits but did not do so. This the court found to be unreasonable.
The court recognized that Ms. Skinder’s doctors consistently supported her claim for disability benefits. Aetna’s sudden decision to ignore such opinions was not right and cherry-pick portions of the medical records to support its termination was unreasonable. For all the reasons, the court ruled in favor of Ms. Skinder.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.
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