Aetna Long-Term Disability Denial

Aetna Long-Term Disability Denials

Insurance companies like Aetna collect billions of dollars from insurance premiums each year. When policy holders don’t fight the denial of legitimate claims, they keep that money, too, and it goes to the profit line. You or your employer may have paid into your long-term disability insurance for years, and you may have a valid disability claim. Nevertheless, many insurance companies will do whatever they can to delay or deny coverage. If your claim was denied, don’t give up. A long-term disability attorney at Robinson & Warncke can help.

Aetna: A Major Player in the Disability Insurance Industry

For decades Aetna has been one of the largest writers of disability insurance in the United States. They are a sophisticated company staffed by highly experienced claims professionals, with ready access to doctors in any medical specialty, vocational experts, and any other resources they need to scrutinize every detail of your claim.  When dealing with such a sophisticated adversary, claimants needs access to professionals of similar (or greater) experience and to experts of superior caliber. The disability insurance specialists at Robinson Warncke are equipped to fulfill all these needs.

In 2017 Aetna entered into an agreement with Hartford whereby Hartford agreed to acquire Aetna’s U.S. group life and disability business for cash consideration of $1.45 billion.  The agreement anticipated covering more than 20 million people insured by Aetna’s group disability and life insurance products.

In its press release, Hartford wrote, “The Hartford also obtains industry-leading digital assets and an integrated absence management platform, which will enhance the experience the company delivers to its customers. . . .Our claims organization continues to use data and advanced analytics across workers’ compensation and disability to drive better outcomes for customers in both business lines.”  Words like “better outcomes for customers” might be construed as euphemisms for “saving money on claims.” For someone with a legitimate, and possibly permanent disability, being subjected to aggressive “absence management” might not feel quite like a “better outcome” at all.

Why Was My Aetna LTD Claim Denied?

Insurance companies can deny your claim for any number of reasons. They may assert that the information they received is incomplete or inadequate. One challenge faced by all claimants is that insurers will not disclose what evidence it would consider adequate. That leaves you shooting in the dark with your proof.

In a recent case we had against Aetna, we asked Aetna for its “guidelines” on behavioral health claims. Aetna told us in writing it had none. If there are no evidence guidelines, how is a claimant or a claim adjuster to know what would constitute adequate proof? Without guidelines or standards, if a claimant tries to send more detailed evidence in response to a denial, Aetna can simply identify some other item that is allegedly missing and keep denying and delaying. An experienced disability attorney will have a sense of the highest and best form of evidence for any disabling condition. Obtaining the best, most detailed proof from the beginning will massively improve your chances of recovering benefits without having to resort to litigation.  And if Aetna still denies the claim, you will have developed the best possible record to support a lawsuit against them or file an appeal. To learn more about appeals, read our article Should I Handle My Own Appeal?  

Policy Provision Denials and Restrictions

Aetna (now in conjunction with Hartford) will pay out differently (or not at all) given specific factors. Provisions of the policy that impact the amount of benefits or whether benefits will be paid at all include the following:

• Specific types of illness or conditions may not be covered;
• You may have to meet a highly technical “elimination period” requirements – the waiting period before benefits begin;
• Aetna may assert a coverage problem, such as not being at the employer long enough, not working enough hours, or being terminated before you gave Aetna notice of your disability claim;
• If you become disabled within a year of employment/coverage, Aetna may assert that your claim is barred by a Pre-Existing Condition Exclusion; 
• The benefits last a specific amount of time. Sometimes this duration depends on the age when you became disabled;
• Your disability payments are usually determined by your annual salary. The calculation may or may not include bonuses, commissions, and other forms of compensation;
• Income from other sources could reduce your benefits payments (workers’ compensation, Social Security Disability, and personal injury settlements are common examples); and
• Aetna may require that you go through a period of rehabilitation in order to get yourself back to work.

Aetna policies generally limit or eliminate insurance claims related to psychiatric illness or drug abuse to no more than twenty-four months of benefits. There are, however, some exceptions.

Policy Provision Denials Based on Cause of Disability

In addition to the aforementioned provisions, your claim may be denied based on how you became disabled.  Generally speaking, most policies do not offer coverage for disabilities that were caused by:

• Acts of war, riots, or insurrection;
• Injuries sustained during civil unrest or a criminal event;
• DUI-related injuries; and
• Self-inflicted injuries.

Insurance Companies Profit from Denials and Delays

Unless your claim file is nearly perfect, the insurance company may try to deny your claim.

Why do they do this? Well, think about it like this: Insurance companies earn their money by collecting premium payments and investing them. The longer the money stays invested, the more money they earn. Thus, when insurers delay paying claims, or manage to avoid paying them entirely, their investment earnings increase and become a part of their profits. 

Speak to an Aetna Long-Term Disability Denial Lawyer

Do not be intimidated by an Aetna long-term disability denial. In most cases, you can remedy the situation by submitting a thorough appeal that addresses all the provisions of the insurance policy and the reasons for denial. At Robinson Warncke, we have helped thousands of claimants recover funds owed to them by LTD insurance providers. Contact us today to learn more about how we can help you fight a denial.