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ERISA and Aetna Long Term Disability Appeals

ERISA and Aetna Long Term Disability Appeals

 

If you are denied an Aetna Long-term disability claim the good news is that you can appeal that decision!

The first thing you should know is that while all Aetna long-term disability plans are not all the same, many are governed by a law known as ERISA.  ERISA is a federal law that mandates how employer-provided long-term disability policies must be administered, and how the appeals process must work for denials & adverse benefits determinations.

Here are things you need to know to begin filing an appeal for an Aetna disability denial.

 

Read Your Denial Letter

Read your denial letter and understand exactly why you were denied.  Initially, your best understanding of why your claim was denied will come in the details of the denial letter.  If you need help making sense of this letter, reach out to us and we will help you.

 

Request Your Claim Documentation

Request your claim file, Aetna long-term disability policy, and Aetna is required by law to send you free copies of these when requested.

 

Gather Any Additional Evidence That Will Help Your Case

Have friends and family write letters to Aetna explaining how your disability affects your day to day life. For example, If your wife has to help you get in and out of the car each time, then she should write a letter explaining that.

Ask your doctors for written opinions. You should already have medical records from your doctors, but having their opinion in writing can also help paint a picture of how your disability affects your ability to work.

Seek out medical records that did not get submitted in your original claim.  Make sure to include employment records too, including, annual reviews, accommodations, citations, awards, letters, and anything else that might be related to your previous employment and the barriers you face(d).

Your goal in this step is to work on stacking the deck” for your appeal.  Once you have made your appeal, you will not be able to add more evidence in future appeals or lawsuits.  So getting everything into this appeal is imperative.

 

Start Working on an Appeal Letter

Write an appeal letter addressing that you do not agree with the decision and give reasons why you disagree. You can see our article on How to Write a Long-Term Disability Appeal Letter to understand the best way to frame your letter.

Aetna also has a PDF that you can fill out here: Member Complaint and Appeal Form.  However, we strongly encourage you to reach out to an ERISA attorney before completing this form (or sending your letter in).  If you want to know more about how an ERISA attorney could help, here’s a great article breaking down what exactly an ERISA attorney does in long-term disability benefits claims.

 

Be Timely

Lastly, whichever method you choose to appeal Aetna, do not miss your timelines!

 

 

About the Author
In 1998, Chris obtained his law degree from the University of Oregon, and in 1999, he accepted his first job as an attorney with the Washington State Attorney General’s Office. In 2000, Chris entered a private litigation practice in Vancouver, Washington. In private practice, Chris litigated a variety matters including administrative, criminal, real estate, construction, business, and insurance.