Aetna Abandons Fiduciary Duties to Terminate LTD Benefits for Arthritis Patient

Our client was a Chicago Public School System special education teacher who loved her job. Unfortunately, her hands became effectively crippled by rheumatoid arthritis, forcing her to file for disability benefits. Aetna originally approved both her short-term and long-term disability insurance benefits, but inexplicably terminated them early. We challenged their cancellation through a careful examination of her medical records, ending in a success that reinstated our client’s LTD benefits.

Details of the Crippling Arthritis Case

In August 2016, our client stopped working as a special education teacher because the pain and limitations in her hands from rheumatoid arthritis were simply too much to bear. Aetna granted long-term disability benefits a few months later in November. However, in July 2019, the insurance company terminated the benefits, claiming that she had miraculously recovered from her rheumatoid arthritis, which is a health condition commonly known to be degenerative and disabling. That is to say, it resists treatments and continues to get worse as time goes on.

Right away, our team of disability lawyers knew there was something wrong with Aetna’s approach. It seemed the company tossed aside its fiduciary duty to fairly and accurately assess our client’s health and need for benefits, opting for an easier approach that would save them money in the long run.

While researching our client’s medical records, we found that her doctors said her hands could not:

  • Coordinate, either precisely or generally
  • Grasp, firmly or gently
  • Grip railings, preventing the use of stairs
  • Pinch
  • Push, lift, or pull light objects, like chairs in a classroom

In other words, trusted medical professionals found that any use of her hands could be painful, detrimental, or impossible, resulting in the “permanent disability of her fingers.” A close analysis of internal forms and correspondences shows that Aetna chose to terminate her disability benefits based solely on one doctor’s misunderstanding of the insurer’s methods and questions. Even if the singular form that said our client may be able to perform some light-duty work was not made during a misunderstanding, it would still be one note against the word of an entire medical record from multiple medical professionals who said she should not work in any capacity, including that same doctor who inadvertently provided the contrary note.

Faced with our challenge and the threat of litigation, Aetna backed down. We are happy to say it reversed its termination and our client is once again receiving much-needed LTD benefits.

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