Accenture Employee Forced to File Suit After Aetna Offsets her Workers’ Comp Benefits

An Illinois disability attorney and his client, Joan W. filed a lawsuit against Aetna Life Insurance Company on October 27, 2011 in the United States District Court for the Northern District of Illinois Eastern Division for the insurer’s unlawful actions in regards to the claimant employee’s disability benefits calculations.

Joan W., a 49-year-old Illinois woman, worked for Accenture as a senior project manager until March 8, 2002. In 2002, Joan W. ceased working due to sustaining a closed head injury when she was involved in a motor vehicle accident. Her closed head injury causes Joan W. to suffer from “chronic seizure disorder, cervical fractures with fusion of C2 through C5 with associated radiculopathy and traumatic brain injury.”

Illinois Claimant’s Workers’ Compensation Benefits Jeopardize Her Aetna Disability Benefits

After receiving short term disability, Joan W. was approved for her long term disability benefits in January 2004. Then, on December 17, 2001 Joan W. received workers’ compensation in the amount of $270,000.00. As a result of the workers’ compensation award, Joan W. received notification from Aetna that her disability benefits would be offset by the workers’ compensation settlement in January of 2011 with Aetna attempting to use its policy’s “other income benefits” provisions as justification for denying Joan W. part of her disability benefits. Joan W. appealed this decision and pointed out that her Social Security Disability Benefits were not offset because Joan W.’s lien for workers’ compensation was extinguished, which is legally viewed as Joan W. never receiving workers’ compensation at all. No offset is permissible when a workers’ compensation award is the result of a Third Party Settlement as in the case of Joan W., so it should not be calculated as income for the purpose of determining disability insurance benefits by law.

Ninety days elapsed after Joan W. filed her appeal and Aetna has not responded to the appeal. Consequently, Joan W. and her Illinois disability attorney are allowed to deem her appeal options to be exhausted, thus making way for the filing of the subject lawsuit. In the lawsuit Joan W. and her Illinois disability attorney allege that Aetna “had no right to offset [Joan W.’s] LTD [(long term disability)] benefits by her workers’ compensation settlement” and is “entitled to all LTD benefits that were [previously and continue to be] offset in accordance with the alleged overpayment” of her disability benefits. They opine that Joan W. should continue to receive the full amount promised in her Aetna policy terms and conditions.

Claimant’s Illinois Disability Attorney Demands Justice for Client

In the complaint, Joan W. and her Illinois disability attorney ask the District Court to:

  • Enter a judgment in Joan W.’s favor to force the insurer to pay her “all withheld LTD benefits” in an “amount equal to the contractual amount of benefits to which she is entitled,” according to the policy’s plans and state that “no workers’ compensation offset was ever due”;
  • Award Joan W. prejudgment interest;
  • Order Aetna to continue paying Joan W. long term disability benefits in the amount stated in her policy;
  • Make Aetna pay Joan W.’s attorneys’ fees and court costs; and
  • “Recover any and all other penalties, damages, and relief to which she may be entitled.”