When you opted into your Ohio employer's long-term disability insurance coverage through Aetna, you did so, hoping you would never have to file a claim but feeling good you and your family would be covered if you suddenly could not work because of an injury or illness.
However, when that fateful day arrived, and you filed your claim to get the benefits you had paid into for so many years, your claim was denied. What rights do you have in this circumstance?
ERISA Guarantees Your Right to an Appeal an Aetna Denial
Employer-sponsored benefits, including long-term disability (LTD) insurance policies, are governed by the federal Employee Retirement Income Security Act (ERISA). This act guarantees employees the right to appeal a denial of benefits, but they also make the appeals process difficult. By setting short deadlines and only giving employees one chance at an appeal, ERISA stacks the deck against the disabled employee.
To improve your odds of a successful appeal, you need to understand how an appeal works and hire an ERISA attorney to guide you through the process.
Checklist for Appealing an Aetna LTD Denial
While we don't recommend filing an appeal on your own, we think it's important to understand the appeals process's steps. At Monast Law Office, we'll help you work through the following checklist:
- Note the deadline to file an appeal. You only have 180 days from the date you received a denial to file an appeal. Mark this date down, and don't delay in completing the rest of the checklist.
- Request your claim file from Aetna. Before you can prepare an appeal, you need to understand why Aetna denied your original claim. Get a copy of your updated file, and make sure you have a copy of the LTD policy.
- Gather all of your medical records. Since you only get one shot at an appeal, you need to make sure you present all medical evidence. Request records from every doctor you saw about your injury or illness. If your condition has worsened since your last visit to any of the providers, schedule a visit so your doctor can update your records.
- Stop using social media. The insurance company may look at Facebook and other social media accounts for evidence that you're not disabled. The wisest thing you can do at this point is to delete recent pictures and stop posting or commenting until the appeal is complete.
- Document your work duties. The key to a successful disability claim is proving that you cannot perform your job's tasks. Getting a statement from your employer and providing an account of all of your duties will be necessary for a strong appeal.
- Collect disability approvals from other agencies. If you were approved for Social Security disability, workers' compensation, or another source of disability-related income, these documents will support your appeal to Aetna.
- File your appeal. To win an ERISA appeal, you must prove that you cannot work due to your disability and that Aetna acted unreasonably in denying your initial claim. This is a high standard to meet and should be handled by an attorney.
If this checklist is overwhelming, that's understandable. There's no need for you to have to navigate this process by yourself. As soon as you get notice of your LTD claim denial from Aetna, contact my office for help.
Contact Monast Law Office With Your Questions
I'm dedicated to helping clients denied an employee benefit covered by ERISA, including long-term disability. Contact our office in Columbus to discover how we can help. To learn more about ERISA and the appeals process, request a free download of our book, Don't Go It Alone: How Insurance Companies Sabotage Disability Claims. Don't let your chance at a successful appeal pass you by. Contact us today!