Aetna Life Insurance Company has attracted significant judicial scorn of late in the manner in which it adjudicates disability benefits.Two recent decisions are illustrative - Jalowiec v. Aetna Life Ins. Co., 2015 WL 9294269 (D. Minn. December 21, 2015) and Granville v. Aetna Life Ins. Co., 2015 WL 9026025 (M.D. Pa. December 15, 2015).In Jalowiec, which involved a disability insurance claimant who suffered from daily debilitating headaches, a benefit claimant was denied long-term disability insurance benefits despite certification of his disability by several treating doctors.The court criticized Aetna for its reliance on reviewing doctors who engaged in a selective consideration of the evidence and who never consulted with the treating doctors to seek clarification of their opinions.
A recent ruling issued by a federal court in Philadelphia illustrated a number of issues relevant to disability insurance claims brought under ERISA.In Charles v. UPS Long Term Disability Plan, 2015 WL 6600399 (E.D. Pa. October 29, 2015), after first finding the plaintiff was limited to part time work and thus unable to work at an occupation that would generate an income equal to 60% or more of pre-disability earnings, Aetna shifted gears and denied benefits.The claimant had been a delivery driver for UPS who became disabled on account of a seizure disorder and could no longer qualify for a commercial driver's license based on the condition and the prescribed anti-convulsant medications which cause sedation and fatigue. The plan's insurer, Aetna, had the file reviewed by doctors and vocational consultants who issued findings that Charles could work full time and that there were occupations he could perform that would generate the requisite wages.The court overturned that finding in a harsh ruling that included the quotation that is the title of this blog.