Aetna, a CVS Health Company, was founded in 1850 and is now one of the giants of the insurance industry. A Fortune 100 company, Aetna employs nearly 50,000 people worldwide and has an estimated 37 million clients. In any given year, Aetna collects nearly $30 billion in premium revenue.
Aetna sells a variety of health and insurance plans including employer-provided group disability insurance policies. These policies provide employees with monetary benefits if they are unable to work due to an illness or injury.
Why Did Aetna Deny My Long-Term Disability Benefits?
Aetna is guilty of denying a disturbing number of worthy long-term disability (LTD) claims every year. They know that their clients are vulnerable and are not in the best position to put up a fight. Though their website appears that they are people-focused, what Aetna is really worried about is their bottom line. Aetna disability claim denials are well known to our firm, but they often come as a surprise to the hard-working people who are the victims.
There are several reasons why Aetna may deny your LTD claim. One reason is that their process is set up for you to fail from the beginning. It’s no secret that the majority of LTD claims are denied the first time. Aetna often words their disability applications in such a way to solicit a denial.
If you are unsure as to why Aetna denied your claim, these questions might help:
Do You Meet Your Policy’s Definition of “Disability”?
The definition of disability may differ depending on the plan your employer chooses. Most plans have an “any occupation” or an “own occupation” definition of disability. Your plan may consider your inability to perform any work tasks as a disability or, you may be considered disabled if you are unable to perform the duties required for your own job/career. It’s important to know which plan your employer chose prior to submitting a claim.
If you fail to meet the correct definition, Aetna will deny your claim.
Do You Suffer From Any Excluded Injuries or Disabilities?
Long-term disability (LTD) insurance benefits provide beneficiaries with a portion of their income in the event that they cannot work for an extended period—due to a covered sickness or accidental disability.
Depending on your policy, some injuries and illnesses are excluded from receiving disability insurance benefits. For example, certain mental illnesses, drug or alcohol addiction, and self-reported illnesses may be on your policy’s list of excluded disabilities.
Aetna may also claim that your disability is due to a pre-existing condition.
Does Your Medical Record Have Enough Evidence to Support Your Claim?
Your claim will pass through the hands of a disability claims examiner and an in-house reviewing doctor who will cherry-pick your medical records, selecting only the portions that will support a denial of your claim.
Submitting a complete copy of your medical records will guard against cherry-picking. Your doctors should be performing tests such as MRIs and CT scans and those results should be recorded in your file. You should also have your doctor and attending specialists indicate any limitations that your injury/disability has caused you. With this information, the insurance company will have trouble coming up with reasons to deny your claim.
Were You Caught on Surveillance Doing Activities Your Disability Should Prevent You From Doing?
Be aware while doing every-day activities like getting groceries or walking your dog. Aetna has deep pockets and will almost certainly hire a private investigator in hopes of catching you doing something that your disability should prevent you from doing. Sometimes it’s worth consulting an experienced LTD attorney because they will best be able to explain to the long-term disability insurance company that the 10 minutes you were filmed having a “good day” is not indicative of your disability as a whole.
It is also best to avoid posting pictures or comments about your injury or disability on social media. It may be hard to prove that a photo taken before your injury isn’t recent and comments may be taken out of context. All correspondence about your injury or disability should only involve you and your doctor(s).
Can I Appeal My Aetna Long-Term Disability Denial?
If your disability claim is denied by Aetna, you have every right to appeal their decision and fight for your benefits. Because ERISA governs employer-provided group disability insurance plans, you are required to exhaust Aetna’s internal appeals process before you will be allowed to file a lawsuit in court.
Your denial letter will tell you why the company decided to deny your claim and will outline how you can file an appeal as well as the deadline for doing so.
Don’t miss this deadline! If you do, you will not be able to try to recover benefits for your disability from Aetna in the future.
Often, you have 90 days or less to file your appeal.
How Do I Appeal an Aetna Denial?
Aetna has no lack of resources to deny, delay, and terminate disability claims. They realize many of their claimants are not in the best position to push back and expect them to put up with delays and quietly accept a denial.
If your Aetna LTD insurance claim was denied, you should contact an attorney as soon as possible. We provide nationwide representation for policyholders whose Aetna disability insurance claims were wrongfully denied, delayed, or terminated.
Though you can file your own claim, going it alone may not be in your best interest. The best course of action you can take if Aetna delays or denies your disability claim is to contact a disability lawyer. A trusted disability attorney has the experience to put your claim in the best light. Working with an experienced attorney familiar with LTD rules and procedures will give you the best chance to win your appeal and secure the long-term disability benefits you deserve.