A Michigan disability attorney recently filed a federal lawsuit in the district court for the Eastern District of Michigan Southern Division against Aetna Life Insurance Company (Aetna). The Plaintiff, Bethany S., worked as a mortgage loan coordinator for Bank of America, thereby making her eligible for an employee welfare benefit plan that was insured and administered by Aetna.
In Bethany S. Vs Aetna Life Insurance Company, the Plaintiff is seeking the short-term and long-term disability benefits at the coverage levels promised under the terms of the Plan.
Facts of the Case
Plaintiff worked as a mortgage loan coordinator for Bank of America. She had been originally employed by Bank of America from July 2003 through November 2008. Plaintiff returned to Bank of America in 2009 and continuing working there until becoming seriously ill.
She was diagnosed with Hashimoto Thyroiditis, Hyperthyroidism, Adrenal gland fatigue, and other ailments, which led to her being extremely exhausted while performing her normal duties as a mortgage loan coordinator. Plaintiff’s condition was also exacerbated by a Bank of America branch manager who caused her significant distress due to humiliating her and other various abusive activities.
On or about August 23, 2010, Plaintiff submitted paperwork and was approved for Family and Medical Leave and short-term disability, leading to her leaving on medical leave due to her medical condition.
Despite attempting the taking of prescription medications, Plaintiff’s treating physicians have deemed her as being “totally disabled.” They also said that resuming work too quickly could result in a relapse and worsening of her condition. This has led to Plaintiff being unable to resume the normal duties of her occupation.
Denial of Disability Benefits by Aetna
On November 18, 2010, Aetna terminated Plaintiff’s short-term disability benefits. This was done without proper medical or factual foundation.
The terms of the Plan state that a recipient need only show that he or she cannot perform the essential functions of his or her occupation for a period of over seven consecutive business days and be deemed disabled by his or her treating medical providers. These conditions were satisfied by the Plaintiff, thereby making her eligible for short-term disability benefits. Aetna had paid for STD benefits from August 2010 through November 18, 2010.
Plaintiff filed an appeal of Aetna’s decision on April 27, 2011, providing Aetna with objective medical test results of the Plaintiff’s thyroid auto antibodies to prove that she satisfied the terms of receiving STD benefits.
Aetna did not reply to the Plaintiff’s appeal. On September 7, 2011, Plaintiff notified Aetna that its time to decide upon the Plaintiff’s appeal had passed according to the U.S. Department of Labor’s regulations applicable to Section 503 of ERISA. This would lead to the Plaintiff’s appeal being denied.
Plaintiff has exhausted her administrative remedies, leading to the filing of this lawsuit against Aetna.
Michigan Disability Lawyer Files Lawsuit Against Aetna
According to the lawsuit, Aetna failed to provide the following to the Plaintiff:
- A timely determination of her appeal of Aetna’s original denial of STD benefits
- A fair review of the medical documentation provided by the Plaintiff in regards to her medical condition and its eligibility for STD benefits
- A fair appeals process due to Aetna’s conflict of interest that violates the rights of participants under ERISA to have full and fair reviews of their claims by appropriate and fair fiduciaries as promised by ERISA section 503
- The short-term and long-term disability benefits that the Plaintiff was entitled under terms of the Plan
Plaintiff Seeks Following Relief In The Aetna Lawsuit
Due to Aetna’s actions, Plaintiff seeks the following relief from this Court:
- A judgment that grants Plaintiff all benefits due to her, along with prejudgment interest
- A judgment that grants Plaintiff all appropriate attorney fees
- A judgment that grants Plaintiff all associated court costs
- A judgment that grants Plaintiff all other relief that the Court deems fair and proper