How Do I Appeal an Aetna Long-Term Disability Denial?

Aetna disability may offer short and long term coverage for debilitating injuries and conditions, although the risk of denial may be significant.

What is Aetna Disability?

The reason for having a long-term disability policy is to protect your income in the event you become unable to work. In many cases, these policies are part of a benefits package through an employer. In some cases, people buy disability policies directly from an insurer. One such insurer is Aetna, which offers both short-term and long-term disability insurance.

“Losing your income can be a life-changing event,” Aetna’s website notes. “The Aetna Short-Term Disability Plan provides income protection if the member becomes disabled and is unable to work.”

According to the company’s website, benefits are paid weekly for up to six months and can help compensate individuals for everyday living experiences.

Aetna notes that its disability insurance provides advantages for employers in the form of voluntary offerings, affordable employee-paid premiums, simple to offer design, as well as employee satisfaction, retention, and productivity. On the flip side, Aetna says that employees also see benefits in the form of affordable group rates through payroll deduction, uniform rates regardless of age, and no medical underwriting.

Aetna Disability Short Term vs Long Term

As the name implies, short term disability covers a disability over a short period of time. Usually, this coverage is responsible for covering disabilities that are not permanent or covering the elimination period before long term disability kicks in.

Is Aetna Good Insurance?

According to The Balance, Aetna is among the best insurance companies of 2020 – winning the title of “Best for Employer-Based Plans.” Pointing to the company’s “excellent reputation” and “excellent financial strength,” The Balance notes that Aetna offers a variety of programs including health insurance and disability insurance along with specialized plans such as HAS plans, gym memberships, weight loss programs, chiropractic services, and more.

As a result of their services, Aetna reportedly received five stars in overall customer satisfaction in the 2019 J.D. Power & Associates Commercial Member Health Plan Study for the Delaware, West Virginia, and Washington D.C. areas. In all 50 states, the company reportedly received excellent financial strength ratings.

However, despite the high praise for Aetna’s capabilities, an insurance company’s primary goal is always to make a profit. They do this by collecting the highest premiums possible and paying out the lowest amount of benefits possible.

This means that in some instances, even if you submit a valid claim for benefits if you have become disabled, your claim may get denied. This can take a serious toll on your finances and many people don’t have an alternate source of income in the event they become disabled. It may be possible that companies like Aetna are wrongly denying long-term disability claims.

Policyholders may face unexpected denials of their Aetna disability claim or claims made with other insurers. This may occur even if someone has a reasonably valid disability claim. Understanding why claims get denied is the first step in getting your claim approved.

In some cases, a condition may not meet your insurance company’s definition of a disability. To make a successful claim for benefits, it is important to make sure your disability is in line with what your policy covers.

In some instances, claims that may be valid may get rejected. However, you have the right to appeal a claim denial.

The Employee Retirement Income Security Act (ERISA) is a federal law that establishes a standard of minimum requirements for retirement plans and disability insurance plans, with the aim of protecting the people who participate in the plans.

Under ERISA, insurance providers must accept or deny a claim in a timely manner and provide reasons why a claim was denied. WikiHow notes that this information should be available in a denial letter provided by the insurance company.

ERISA aims to protect plan participants and applies to plans provided through employers. One of the ways in which the law aims to do this is to guarantee policyholders the right to appeal a claim denial.

If your claim is denied, you have the right to appeal. Under ERISA, you have 180 days to appeal the denial of your benefits claim. If you do not file your appeal in this time, you lose the right to sue the insurer in federal court if your claim continues to be denied.

Making a successful appeal of a disability benefits denial may depend on having the proper documentation in place. This information can include medical records, doctors’ statements, and occupational information. This information may be hard to track down and compile, but a lawyer can help with this process.

Unfortunately, filing a disability claim can require a lot of paperwork, and can involve a lot of technical information. Faced with the stress of filing a claim, some policyholders may neglect to fill out necessary forms, provide important documentation, or miss a deadline. These technical errors can cause a claim for benefits to be denied, even if the claim is otherwise valid.

Filing promptly, with the help of a lawyer, may be your best shot at getting your Aetna disability claim accepted.

A lawyer can help you sort through the complications of bureaucracy, and help you build the strongest case possible. Lawyers can help you track down all the documentation needed to demonstrate your eligibility for benefits. A lawyer can also help you calculate benefits that you may be due as well as file your appeal as quickly and effectively as possible.

Compiling this information in not just important in appealing a claim denial. If your appeal is denied and you choose to sue your insurance company, a court only considers documentation included in the administrative records. Hiring a lawyer can help you “stack your administrative record,” which can be useful both for your appeal and if your appeal is denied.

If necessary, the lawyer can help you file a lawsuit against your insurer if the company continues to deny the claim. Filing a lawsuit may be the best option for recovering compensation for claims that are continually denied.