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.
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.
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.
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:
There are certain circumstances under which Aetna will not provide long-term disability benefits regardless of your health.
As always, check your policy for exclusion and limitations because they vary depending on your plan.
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.
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.
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.