Aetna sued under ERISA in three different cases for denial to pay disability benefits
Three lawsuits were filed by disability lawyers against Aetna Life Insurance for wrongful denial of long-term disability (LTD) benefits on behalf of Bank of America, Southwest Airlines, and Ikon employees.
The First Case
The plaintiff, Ms. F, through a South Carolina disability attorney filed a lawsuit in the District Court of South Carolina Greenville Division. The plaintiff was employed by Bank of America Corporation (BoA). While working for BoA, the plaintiff participated in a short-term disability insurance plan provided by BoA and in a long-term disability plan provided by Aetna for BoA’s employees. BoA fully funded the short-term disability plan, while Aetna provided benefits under the long-term disability plan.
The plaintiff was terminated from her position at BofA in January 2011 due to her medical impairments, which caused her to be absent from work. The plaintiff applied for short term disability benefits, but was denied them. Since Aetna decides upon granting both short-term and long-term disability benefits, Plaintiff would not be granted long-term disability benefits either. Plaintiff still filed for LTD, and was denied by Aetna.
Plaintiff filed lawsuit claiming that Aetna did not make an unbiased decision on her disability, claiming there was a conflict of interest regarding Aetna’s financial interests and using biased information to deny the Plaintiff’s claim.
The Second Case
A Southwest Airlines Company employee filed a disability lawsuit under ERISA to recover disability benefits that were wrongfully withheld by Aetna. Plaintiff became disabled on or around October 8, 2008 and was considered to be covered by the Plan insured by Aetna because he was an employee for Southwest. Aetna, however, has refused to make payments to the Plaintiff as it was supposed to under the terms of the Plan, since it denied his benefits on November 16, 2010 due to a claim that Plaintiff sent a late application for benefits.
Plaintiff appealed this denial and was expected, under ERISA regulations, to hear back from Aetna within 45 days of Aetna receiving the claim, but never did. This has caused undue financial hardship for the Plaintiff.
The Third Case
An Ikon emplyee filed a disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover long-term disability benefits that were wrongfully withheld by Aetna.
Plaintiff became disabled on or about March 15, 2010 and has not worked since. Being an employee of Ikon, who contracted with Aetna to provide long-term disability benefits to all its employees, the Plaintiff was to be covered for his costs. Aetna paid benefits from March 15, 2010 to January 1, 2011.
On January 13, 2011, Aetna issued an “adverse benefits determination” letter, denying the Plaintiff any more benefits from January 2011 onward. Plaintiff appealed this decision in accordance with federal regulations and case law on May 3, 2011. Aetna received this on May 4, 2011. Federal regulations required Aetna to respond within 45 days, though an additional 45 days could be granted if Aetna needed additional time to determine the validity of the claim.
After requesting Plaintiff’s treating physician to complete a Medical Records Reviewer Report, Aetna requested an additional 35 days to determine whether the claim was legitimate. Plaintiff’s lawyer sent a letter on July 26, 2011 indicating that Aetna should not have longer than August 4, 2011 to decide upon the claim. Under any circumstance, Aetna should decide upon the claim by August 11, 2011. However, Aetna never responded to it, hence the lawsuit was filed.
Relief Sought in the Lawsuits
In all of previously mentioned cases, the relief sought by the plaintiffs from Aetna in their lawsuits comprises of:
- A declaration that the plaintiffs are entitled to the specific benefits under their respective plans
- The benefits that are due and have not yet been paid, along with of interest
- An award of attorney’s fees and costs
- Any other relief that the court deems just and appropriate