Appealing an Aetna Long-Term Disability Denial

Posted on April 24, 2019 by cjblog

Insurance companies are supposed to provide you with protection during times of illness or injury. Unfortunately, that isn't always the case. Big insurance companies like Aetna are especially skilled at denying or delaying disability claims. If you received an Aetna long-term disability denial, don't give up. An Ocala FL LTD lawyer may be able to help.

How Insurance Companies Make Money

You may assume that insurance companies make the majority of their profits from premiums paid by policyholders. Think again. Insurance companies frequently invest the premiums which make even more money for them. The amount that insurance companies pay in claims is a drop in the bucket compared to the money they earn.

Aetna collects about $30 billion dollars from insurance premiums in a single year. In order to hold on to as much of these dollars as possible for as long as possible, Aetna often delays processing claims or denies legitimate claims. In some cases, they may terminate your policy in an attempt to avoid paying.

Understanding Your Aetna Long-Term Disability Policy

The purpose of long-term disability insurance is to provide the disabled individual at least a portion of his or her income when they cannot work due to accident or illness. One way Aetna avoids paying legitimate claims is by including numerous limitations in their policies. Here are a few.

  • Excluding certain illnesses or injuries covered under your plan
  • Requiring policyholders to satisfy an elimination period, meaning you have to miss a specific number of days from work before your disability insurance begins
  • Using your age at the time of your disability to limit the amount of time you are covered
  • Requiring you to go through rehabilitation to try and get you back to work
  • Considering the amount of other income to reduce your disability benefit

Limited Disability Benefits for Mental Illness or Substance Abuse

If your disability is due to a mental illness or a substance abuse issue, Aetna routinely limits the amount of time you can receive long-term disability benefits after 24 months. There are two possible outcomes:

  1. If you are an inpatient and your stay will last less than 30 days after the 24 month time period, your disability benefits will stop when you leave the facility.
  2. If you are an inpatient and your stay will last 30 days or more, your disability benefits will continue for 90 days after you leave the facility.

Aetna's Additional Exclusion Groups

There are certain circumstances under which Aetna will not provide long-term disability benefits regardless of your health.

  • If you are in jail or another type of correctional facility as the result of a criminal act or an attempted criminal act
  • Injuries or illnesses due to insurrection, rebellion, a riot or civil commotion
  • Intentional, self-inflicted injuries, even if there is an underlying mental health issue
  • Disability due to war or an act of war
  • A DUI accident in which you were the driver

As always, check your policy for exclusion and limitations because they vary depending on your plan.

After the Denial Letter

If you received a denial letter from Aetna, don't be afraid to act. Insurance companies count on you not putting up a fight. When insurance companies look for ways to deny a legitimate claim it isn't just unfair, it's an unlawful act of bad faith.

In addition to denying legitimate claims, other bad faith practices include delaying claims processing for long periods of time, asking for paperwork you've already submitted, offering you an amount that's less than you are entitled to, or terminating your policy.

An experienced disability appeal lawyer can help you fight these tactics and submit a strong appeal case. You typically have 180 days from the date you receive the notice to file an appeal. Your policy may give you a shorter time, so check the notice carefully as soon as you receive it.

What to Do If Your Appeal Is Denied

If you were unsuccessful in the appeals process, there is one more place you can turn to for help. You can file a complaint with ERISA. ERISA stands for the Employee Retirement Income Security Act of 1974. The act is designed to protect individuals by setting standards for most retirement and health plans. Aetna could be subject to liability if they are not in compliance with ERISA standards.

Appeal an Aetna Long-Term Disability Denial With the Help of an LTD Attorney

Our Ocala FL LTD attorneys can advocate for you in the event you receive an Aetna long-term disability denial or if you file a complaint with ERISA. Contact CJ Henry Law Firm PLLC today to learn more about how we can help.

This entry was posted in Blog by cjblog.