Aetna lost in a Oklahoma Court for failure to consider reliable evidence and ignored the treating physicians opinions. The claimant, Ms. Redden, filed for short-term disability benefits, but was denied. She appealed, and was ultimately awarded the entire short term benefit amount owed to her. She then filed for long-term disability benefits but was denied.
Ms. Redden suffers from sensorineural hearing loss and a visual condition called bilateral optic nerve drusen. Her hearing and vision loss result in cognitive impairments including low attention span and slow processing speed. She also suffers from severe dyslexia, anxiety, and depression. When she filed for disability she worked as a sales development representative for a dental company.
Her disability arose after her job changed its hardware and software systems. The new systems were fast paced and more complex. There was also more background noise where she was, making it more difficult for her to hear and concentrate.
Due to her hearing loss and visual impairments coupled with her dyslexia, anxiety and depression, Ms. Redden could not keep up. The tools she had used to cope with their conditions no longer worked in the fast paced, loud environment.
The stress of her job also increased her anxiety and depression. Ms. Redden received poor performance reviews by her supervisor. She was told she needed to improve her work performance. Ultimately, she was forced to stop working.
Ms. Redden filed for disability benefits with her insurance carrier, Aetna. Aetna denied her long term disability benefits based on reviews conducted by its own doctors. Aetna found that she was not disabled as of the time she stopped working.
In reviewing the facts, the Court noted that Aetna had already found she was disabled during that time frame because it awarded and paid her short term disability benefits. Next, the Court found that Aetna’s doctors ignored the opinions of Ms. Redden’s treating providers.
Additionally, Aetna’s doctors ignored credible evidence in the file. For example, Aetna concluded there was no exam finding of her auditory or visual impairment that would affect her ability to work in her occupation. The Court called Aetna out on this. It went so far as to specifically quote excerpts from her medical records that do cite exam findings.
In the end, the Court found Aetna's decision was arbitrary and capricious and reversed it decision. It awarded Ms. Redden 24-months of benefits under the mental health limitation.
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