The Aetna Life Insurance Company (AETNA) was recently sued in three separate cases in Florida and Texas for denying claims for disability insurance benefits under employee welfare benefit plans that was administered by it. Let us have a closer look at the circumstances of the different cases below.
Lawsuits filed by Bank of America employees against AETNA – Failure to comply with the Provisions of ERISA in claims for disability benefits
The following two cases below both concerned Bank of America’s employees filing lawsuits against AETNA for denying their claims under the Bank of America short term and long term disability insurance plans. Let us examine in more detail the two cases.
Rachel Jones vs. Aetna Life Insurance Company And Bank Of America Corporation
The case of Rachel Jones vs. Aetna Life Insurance Company And Bank Of America Corporation was also filed by a Florida disability attorney for the plaintiff at the District Court for the Middle District of Florida. The plaintiff Rachel Jones was a Bank of America (BOA) employee. By virtue of her employment, she was a participant in the Bank of America Short Term and Long Term Disability Plans which was administered by AETNA.
In the lawsuit, the plaintiff claimed that although she had satisfied all the conditions for her to be eligible for the disability benefits, AETNA had continued to deny both her claim for short term and long term disability benefits. The plaintiff stated that in deciding her claim for long term disability benefits, AETNA failed to act within the stipulated 45 days time frame provided by ERISA. As such, the plaintiff alleged that AETNA had failed to follow claims procedures that were consistent with the requirements of ERISA. It is not uncommon for Aetna to fail to render a claim decision within 45 days.
Christopher Koberstine vs. Aetna Life Insurance Company – Unreasonable Claim Process
The case of Christopher Koberstine vs. Aetna Life Insurance Company was filed at the District Court for the Middle District of Florida for the plaintiff by a Florida disability attorney. The plaintiff Christopher Koberstine was a participant of an employee welfare benefit plan sponsored by his employer and administered by AETNA. The plan provided for both short and long term disability insurance benefits. According to the lawsuit, the plaintiff alleged that AETNA had subjected the plaintiff to an unreasonable claim process by failing to provide a decision within the time limits provided by the Employee Retirement Income Security Act (ERISA). The plaintiff also claimed that AETNA failed to comply with its own internal rules, guidelines, protocols, and other similar criteria relied upon in making the determination to deny his claim for disability benefits.
Relief Sought By The Plaintiff
The plaintiff in this case was seeking from the Court the following relief:
- A declaration of the plaintiff’s rights to the disability benefits under the long term disability insurance policy funded and administered by AETNA.
- Reinstatement of the plaintiff’s rights to the disability benefits under the long term disability insurance policy funded and administered by AETNA.
- An award of attorney’s fees and cost and prejudgement interest.
- Award any such other relief as the Court may deem appropriate.
Richard Devlin Mcnamara vs. Aetna Life Insurance Company
The case of Richard Devlin Mcnamara vs. Aetna Life Insurance Company was filed at the District Court for the Western District of Texas by a Texas disability attorney. The plaintiff Richard Devlin became disabled in 2009. It was stated in the lawsuit that his claim for disability benefits was initially approved by AETNA. He received monthly disability benefits payments from AETNA until September 3rd 2010 when AETNA decided to terminate his disability benefits payment.
The plaintiff appealed AETNA’s decision and had the denial of claim overturned after a review. AETNA issued to the plaintiff on May 24th 2011 its "Final Level Appeal Determination Letter" which stated that "…we have determined that sufficient documentation exists which supports Mr. McNamara’s inability to perform the material duties of his occupation, effective 9/ 3/2010."
However, despite overturning its prior decision to deny the plaintiff his claim for disability benefits, the plaintiff stated that AETNA refused to reinstate his disability benefits payments due to him under the policy.
Relief sought by the Plaintiffs
In both legal actions filed by the Bank of America employees against AETNA, the plaintiffs were seeking the following relief:
- Clarifications of their legal rights under the disability insurance plans
- Payment of all disability benefits due to them under the disability insurance plans.
- An award of attorneys’ fees and costs for the lawsuits.
- Prejudgement and Post judgement interest
- An award for any such other relief deemed just and proper by the Court