Court Orders Aetna to Pay Disability Benefits to California Woman with Multiple Sclerosis

A Court ordered Aetna to pay disability benefits to a California woman after finding Aetna improperly denied herl long-term disability (“LTD”) benefits. The court ruled multiple sclerosis (“MS”) made her unable to do her job. Accordingly, the court found Ms. Kibel was totally disabled under the terms of Aetna’s long-term disability plan.

Multiple Sclerosis

MS is a disease that affects the spine and brain. Typical symptoms of MS include fatigue, weakness, vision problems, cognitive impairments, and others. Sadly, MS is a progressive condition. Still, insurance companies tend to deny claims for MS. This is likely because insurance companies know people with MS will never improve. So, insurance companies attempt to limit their liability by denying disability insurance claims based on MS.

Ms. Kibel’s Case for Long Term Disability Benefits

The Aetna long-term disability policy defined totally disabled as being unable to perform the substantial and material acts of one’s own occupation due to disease or injury. Prior to her disability, Ms. Kibel was employed as a relationship manager at City National Bank. Aetna found she was not disabled from her job and denied her claim for long-term disability benefits. The district court affirmed Aetna’s decision.

Unhappy with the district court’s decision, Ms. Kibel appealed to the Ninth Circuit Court of Appeals. That court reviewed the facts and reached a different conclusion. The court noted Ms. Kibel twice collapsed while at work. It also referenced an MRI which revealed Ms. Kibel had developed 17 areas of brain damage. According to the court, the evidence supported that Ms. Kibel “wanted to, but could not, do her job,” due to the effects of MS.

Notably, the circuit court recognized that Ms. Kibel’s fatigue rendered her totally disabled. Indeed, the court acknowledged that fatigue in MS patients is different than in others. It cited to medical literature which stated “[f]or MS patients, fatigue is ‘an overwhelming tiredness that is not directly related to increased activity.’”

The court also found that Aetna and the district court were wrong in failing to consider Ms. Kibel’s personal statement regarding fatigue. Indeed, Ms. Kibel had asserted fatigue left her “completely drained” and resulted in a “complete slowdown of her brain and body.”

Ultimately, the court concluded Ms. Kibel had established she was totally disabled. It therefore reversed the district court decision and instructed the district court to direct an award of long term disability benefits to Ms. Kibel.

Dabdoub Law Firm Can Help

Our firm has represented many clients with MS. Our disability attorneys understand MS and disability insurance laws. The firm focuses on long-term disability claims and has experience with virtually all disability insurance companies, including Aetna.

Give us a call so that we may help you with your claim for long-term disability benefits.

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