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Appealing a Denial of Disability Benefits from Aetna

Osterhout Berger Daley > Insurance Companies > Appealing a Denial of Disability Benefits from Aetna

If you are a worker who has purchased one of Aetna’s disability insurance policies, it may offer you a safety net in the event that you are left disabled and unable to return to your job on a short-term or long-term basis. Some people who have disability insurance policies through Aetna are denied when they file claims for benefits. If you are denied, the experienced disability attorneys at Osterhout Berger Daley may be able to help you with appealing the decision and securing benefits.

Background on Aetna

If you opted to get Aetna’s disability insurance through your employer, you deserve to take full advantage of the benefits that come with the plan should you find yourself unable to work due to an injury or illness. Unfortunately, there are many cases where insurance companies, like Aetna, delay or deny an insurance claim hoping that you won’t question the reason why or attempt to appeal their decision. However, you should fight to get what’s rightfully yours when you opt to use one of their disability insurance products.

What is Aetna insurance?

The Aetna Inc. is a giant health care company that made over $60 billion in revenue in the last fiscal year. They are publicly traded and claims to serve over 37 million people. Their services range from medical plans to behavioral health programs.

Understanding disability insurance from Aetna

Aetna offers both short-term and long-term disability insurance to allow employers to help protect employees fill their income gap from the time they stop working until they can return to work.

Aetna short-term disability

If you suddenly find yourself unable to work for a short period of time, Aetna offers short-term disability insurance through your employer to help cover a portion of your income while you’re recovering. With Aetna, only certain injuries and illnesses qualify as a disability. These injuries and illnesses are described in your plan’s summary. Aetna requires that you miss a certain amount of days before you can start collecting your disability pay. You’ll only be able to collect disability for an allotted amount of time before you’ll have to switch to long-term disability insurance if you qualify and have opted to receive this through your company.

Aetna long-term disability

Aetna’s long-term disability insurance has the same limitations as the short-term disability plan. One difference is how long you’re able to collect disability pay through the long-term disability plan. While the pay for the short-term plan is based on time, the pay for Aetna’s long-term disability is based on your age at the time the disability happened. There are, however, two exceptions to that rule. If your disability is due a mental health or psychiatric condition, or from alcohol or drug abuse, your benefits will stop coming after 24 months. If you have to be hospitalized or sent to a treatment facility due to mental reasons or substance abuse, your benefits may continue for a while longer. Again, your plan summary will have a more detailed explanation of the plan’s benefits.

What you need to know about Aetna claims

It’s fairly typical for an insurance company to delay or deny claims as it means they get to hold on to the money and forgo paying you. However, the tactics in which these companies use to justify the delay or denial of the claim typically do not hold up in a court of law. What these companies bank on is that the policyholder not question the reasons why they’ve delayed or denied the claims. Instead of sitting back and accepting their findings, you should fight back and appeal their decision.

How do I submit a claim to Aetna?

To submit a claim to Aetna, you’ll have to fill out their Disability Claim Form and mail it in to the address found on the form. The top half of the form will have to be completed by your employer while the bottom half of the form is to be completed by you. Information about the company you work for, the disability plan you have, your job including your salary, and whether you have life insurance through Aetna will all be required of your employer. You’ll be responsible for filling out the information about yourself and your disability. Once the claim has been submitted, you can follow its status through Aetna’s WorkAbility Management System.

What do I do if Aetna delays my claim?

If Aetna delays your disability claim, you should reach out to disability lawyer at Osterhout Berger Daley. One of our highly capable lawyers can review your Aetna plan and file any necessary appeals.

What do I do if Aetna denies my claim?

If you received a denial letter from Aetna regarding a disability claim, you should seek help from a disability lawyer. While the first line of action is to appeal the decision, if the appeal isn’t thorough it’s very easy for the insurance company to deny the appeal. This is why gathering evidence of the wrongful denial is important. There have been many cases where policyholders who’ve submitted a claim have been videotaped by an Aetna representative to prove that the disability is real or have been sent to a doctor of Aetna’s choosing to get a second opinion of the disability. These methods have been known not to stand in a court of law, but insurance companies continue to employ these tactics and many others in the hopes that you, the policyholder, is none the wiser. Our disability lawyers can build a case against Aetna and make sure that the appeal sticks.

Appealing a claim that was denied by Aetna

To appeal a claim with Aetna, you can either fill out and mail their Member Complaint and Appeal Form or call their Member Services phone number. Aetna’s timely filing deadline is within 180 days of getting the denial letter. However, your summary plan may say something different, so make sure to follow what it says. Again, it’s fairly easy for companies like Aetna to deny your appeal leaving you to file for a second time. Rather than waiting to appeal a second time, let Osterhout Berger Daley Law help you the first time.

Our team of experienced attorneys.

How Osterhout Berger Daley can help

There will be a deadline for your appeal that will be listed in the letter. Do not miss this deadline. If you do, you will be barred from claiming benefits from Aetna for your disability in the future. Request a copy of your claim file, and bring your file and your denial notice to the experienced disability team at Osterhout Berger Daley. Our experienced attorneys may help you to build the evidence that you need to win your appeal. Contact us today to schedule your consultation.

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    Learn more about long term disability insurance, as well as appealing denials and how an attorney can help. These five articles will cover the basics: