Aetna disability insurance claims are very common in our practice. Aetna is one of the largest long-term disability insurance carriers in the country. Because of that, our firm has handled hundreds of Aetna disability claims. Our disability insurance attorneys have experience handling long-term disability appeals and lawsuits against Aetna.
Most long-term disability policies insured by Aetna are group policies. This means that your employer offers the option to enroll to its employees. If you received your long-term disability policy through work, then you have a group policy.
A federal law called ERISA sets the standards for most group long-term disability policies. ERISA stands for the Employee Retirement Income Security Act of 1974. This federal law sets certain rules that disability insurance companies like Aetna must follow. It also sets rules that you must follow. These rules are strict. Understanding the rules that apply to you can be difficult.
In addition to the ERISA rules themselves, there are a number of cases where judges have interpreted the ERISA rules. These cases create a new body of rules called “caselaw.” This caselaw helps determine how the ERISA rules should be applied in different situations.
Our firm knows which rules you must follow and what rules Aetna must follow. We also know when Aetna is stretching the rules. We can help you look out for these pitfalls.
What Does Aetna Do When You File A Claim?
Aetna commonly denies claims for disability benefits arguing that you did not submit objective evidence. Objective evidence usually means some sort of objective testing like an MRI, PET scan, CAT scan, blood testing, etc. This makes filing a claim based on pain, fatigue, or any other subjective symptoms nearly impossible.
Aetna cannot require objective evidence unless your policy requires it. Most of Aetna’s policies do not contain an objective evidence requirement. So, you must check your policy closely.
Courts have recognized that some conditions like fibromyalgia, chronic fatigue syndrome, and chronic pain cannot be proven with objective evidence. There is no way to prove fibromyalgia with an MRI or similar test. With these conditions, your doctor needs to follow the best practices for diagnosis. Aetna cannot deny your claim for fibromyalgia related pain because of you failed to submit objective medical evidence.
So, although Aetna often states “no objective evidence” as a reason for denial or termination, it usually cannot do so. It is important to address this issue in any appeal against Aetna.
How We Can Help
Our experienced disability insurance attorneys have handled hundreds of Aetna disability claims, appeals, and lawsuits. We know what to look for with each case against Aetna.
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