Aetna's Disability Benefit Termination Thwarted

Ben Glass

Attorney
(866) 735-1102 Ext 320

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In a recent case in federal court the judge ruled that Aetna Life Insurance Company's decision to permanently terminate disability benefits to an employee was wrong and those benefits would be reinstated. Most disability insurance companies will only make payments to you if you are disabled and under the "regular care and attendance" of a physician. Here there was a period of time during which the employee was not under the regular care of a physician. Aetna terminated the benefits permanently.

The police terms were "Aetna' will not pay for any disability ... during which a covered individual is not under the regular care and attendance of a physician."

The court found that this meant that Aetna could suspend payments only for that period of time during which the employee was not under the regular care of a physician and that Aetna's decision to permanently terminate benefits was an abuse of its discretion and misreading of the policy.

Comment from Virginia Long-term Disability Attorney Ben Glass:

Many insurance companies will stop at nothing to get you off their claim files. All denials and terminations should probably be reviewed by an experienced long-term disability attorney.

Clark v. Aetna Life Insurance Company, decided February 2, 2007 in the Southern District of New York.