In this video, Attorneys Gregory Dell and Cesar Gavidia discuss a current case Mr. Gavidia is litigating in Federal court concerning Aetna’s initial granting, then denying, long term disability benefits to a software engineer who suffered a stroke in 2011. He later returned to work, but after about three years, he started having issues with cognitive, visual, auditory, spatial, and perceptual functioning that interfered with his ability to do his job, so he filed a claim for long-term disability benefits with Aetna Insurance Company.
To support his claim, the engineer submitted his medical records from his neuropsychologist and reports of cognitive testing. Aetna’s own medical professionals agreed with the reports, so Aetna approved his claim. About 18 months later, benefits were terminated. As a basis for its denial of any further disability benefits, Aetna relied somewhat on the claimant’s social media postings that indicated to Aetna that the man was not disabled. Aetna also denied his administrative appeal.
That is when Mr. Gavidia became involved in the case and filed an ERISA lawsuit in Federal court. The main litigation issues are: 1) The policy appears to only require claimants to be disabled from their own occupation, but denial letters say he must be disabled from any occupation; 2) Aetna chose an incorrect specialist to examine and review the records. It should have chosen a neuropsychologist; 3) Aetna’s neurologist only spent about 30 minutes with the claimant, conducted only a screening test, and did not review raw data from the claimant’s treating physician’s neuropsychological testing.