Aetna Disability and filing LTD Insurance Appeals
Aetna is one of the largest LTD companies offering policies today. If you wish to appeal a denied claim you should seek legal assistance.
Author: Attorney Lonnie Roach
Aetna is an American managed health care company and is a descendant of Aetna Fire Insurance Company of Hartford, Connecticut. In the 1990s, Aetna acquired U.S. Healthcare, NYLCare Health Plans, and Prudential HealthCare, making it the largest provider of health benefits in the United States. Aetna announced plans to purchase Humana for $37 billion in cash or stock in 2015, but a federal judge blocked the sale in January 2017, concerned that senior citizens would be left with fewer options for Medicare.
A Fortune 500 company, Aetna earned a total revenue of $63.16 billion in 2016 and in December 2017 was purchased by CVS for $69 billion.
Aetna provides a suite of insurance products and services including:
- Health expense funds
- Health and wellness programs
- Behavioral health programs
- Life Insurance
The company serves a wide population of consumers and health care professionals which includes:
- 23.1 million members
- 14.3 million dental members
- 15.3 million pharmacy benefit members
- 13.609 million group insurance members
- 1,200,000 health care professionals
- 695,971+ primary care doctors and specialists
- 5,712 hospitals
If you have been denied long-term disability benefits don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.
Aetna provides both short-term (STD) and long-term disability (LTD) insurance, available only through an employer.
Short-term disability benefits are weekly while long-term disability provides a monthly benefit that is typically equal to 50-60 percent of an employee’s eligible pay. Employees may be eligible to receive LTD benefits after the exhaustion of their STD benefits. Aetna advises employees to discuss with their plan administrator which disability plans are available to them and cautions its members to know their plans and its terms:
- Only certain illnesses or injuries are covered under your plan.
- You need to miss a certain number of work days before your disability pay starts. This is called an elimination period.
- Benefits last for a specific period of time. Your age at the time you became disabled may affect how long benefits last.
- You may be required to undergo rehabilitation services to help you return to work.
- Other income you have during your disability may affect the amount of your benefit.
- The amount of disability benefits you receive is usually based on your annual salary, commissions or other forms of income from your employer, depending upon your disability plan.
Aetna accepts claim notification via toll free number, web-based customer portal or paper, but if you are out of work due to an illness or injury, you should call Aetna’s toll-free number by the third consecutive day of absence to speak with the Disability Service Center (1.866.326.1380; 8:00 a.m. – 8:00 p.m. EST, Monday through Friday).
During the initial intake, a member’s short-term disability eligibility is verified and the claimant is informed about the claims process. The Disability Specialist will:
- Inquire about the illness or injury
- Ask you to describe your occupation
- Begin the claims process.
Aetna staff will contact your employer to verify eligibility and confirm information about job duties as well as your medical providers for medical information.
The claims process takes approximately 14 days. You should also file a Medical Release at the time you report your disability to prevent delay.
When the claims procedures are complete, you will receive notification in the mail stating a certified length of disability and a communication will be sent to your employer stating when you can be expected to return to work.
Once the period of disability is certified, you will begin receiving payments. If you are unable to return to work after the designated period, you must provide supportive evidence prior to the certified disability date. In the event you are expected to be out of work for an extended period of time, Aetna’s representatives will be available to assist you in applying for Social Security Disability Income.
According to its website, Aetna’s goal is “to make health care simpler, more accessible and convenient” by improving its members’ digital experience and providing tools to make health care services and information easy to obtain.
If you have Aetna disability insurance coverage and are on short-term or long-term disability leave, you may use the WorkAbility® Absence Management System to:
- Get a claims status
- Take action through online alerts
- View copies of letters and forms
- Complete and sign forms online
- View and print copies of pay stubs
- Sign up for direct deposit or request a prepaid debit card
- View and print copies of your tax forms (1099, W-2)
- Add time to intermittent leave
Go to www.aetnadisability.com to register. You can also have access to your disability claims via mobile phone.
If Aetna denies your claim, you will receive a letter stating the reason for denial and the procedure for appeal. Because Aetna long-term disability policies are provided by or purchased through an employer, they are governed by The Employee Retirement Income Security Act or ERISA which requires a claimant to “exhaust administrative remedies” before filing suit.
Claimants have 180 days to appeal and insurers have 90 days to consider the appeal which equals 270 days a disabled person is without income. Claimants may be advised to file for Social Security Disability Income when filing a claim, but insurers may deduct any Social Security Income from insurance benefits and, if a claimant does not file for SSDI, the insurer may claim the disabled person has breached an LTD policy requirement. ERISA permits insurers to administer their own plans and a denial can only be reversed by demonstrating that the insurer abused that discretion – which is very difficult to do. If an internal appeal is denied, filing suit in U.S. District Court is a claimant’s last option.
ERISA disability disputes can be long and drawn out and few disabled people have either the resources or physical stamina to fight with a large insurance company.
That is why it’s important to have a qualified attorney with extensive experience in LTD disputes and ERISA to organize and manage your case. Partner and long-term disability attorney Lonnie Roach of Bemis, Roach & Reed has successfully overturned denials of disability benefits at the administrative level, in United States District Court, and at the United States Court of Appeals. Presently Lonnie represents clients who have been denied or lost insurance, long term/ ERISA or Social Security disability benefits in all four federal districts in Texas. If you have been denied long term disability benefits, Bemis, Roach & Reed offers a free consultation to determine if we can assist you in obtaining or reinstating those benefits. Please contact us at 512-454-4000 and get help today.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
Bemis, Roach & Reed has helped clients who are disabled from a wide variety of medical conditions. If you are unable to work due to any of the following conditions and have been denied disability benefits, contact us. We would like to help.
- Acid Reflux
- AIDS / HIV
- Alcohol Dependence
- Amyotrophic Lateral Sclerosis ("ALS")
- Autoimmune Disorder
- Back Pain
- Bipolar Disorder
- Bladder Control
- Blood Disorder
- Brain Aneurysm
- Brain Tumor
- Breast Cancer
- Bulging / Herniated Disc
- Cancer (all kinds)
- Car Accident
- Carpal Tunnel Syndrome
- Cerebral Atrophy
- Cerebral Palsy
- Cervical Disc Disease
- Chronic Fatigue Syndrome
- Chronic Obstructive Pulmonary Diseases (COPD)
- Chronic Pain Syndrome
- Congestive Heart Disease
- Congnitive Dysfunction
- Coronary Dysfunction
- Crohn’s Disease
- Cystic Fibrosis
- Degenerative Disc Disease
- Down Syndrome
- Epstein-Barr Virus
- Essential Tremor
- Falls and disability
- Gastrointestinal Reflux
- Hearing Impairment
- Heart Failure
- Hepatitis C
- Herniated / Bulging Disc
- High Blood Pressure/Hypertension
- Hip Replacement
- Hodgkin’s Disease
- Huntington’s Disease
- Interstitial Cystitis
- Irritable Bowel Syndrome (IBS)
- Ischemic Heart Disease Disability
- Kidney Disease
- Knee Disorder/Replacement
- Liver Cancer
- Liver Disease
- Lumbar Disc Disease
- Lumbar Radiculopathy
- Lung Cancer
- Lyme Disease
- Macular Edema/Degeneration
- Memory Disorder
- Menieres Disease
- Mental Illness
- Multiple Myeloma
- Multiple Sclerosis
- Muscular Dystrophy
- Myofascial Pain Syndrome
- Neurocognitive Disorder
- Parkinsons Disease
- Peripheral Neuropathy
- Post-Traumatic Stress Disorder (“PTSD”)
- Prostate Cancer
- Reflex Sympathetic Dystrophy (“RSD”)
- Rheumatoid Arthritis (RA)
- Seizure Disorder
- Sjorgen's Syndrome
- Skin Cancer
- Sleep Apnea
- Spinal Stenosis
- Systemic Sclerosis
- Temporal Mandibular Joint Dysfunction (TMJ)
- Throat Cancer
- Traumatic Brain Injuries
- Vision Impairment
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