Why was my Aetna disability claim denied?

Policy holders 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.

Why did my claim get denied?

Insurance providers are companies, and have profit in mind. Some customers may claim that the companies make profits by collecting the highest premiums possible, and making payouts for the fewest benefits claims possible. 

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

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. 

What rights do I have as a disability policy holder?

The Employee Retirement Income Security Act (ERISA) gives policy holders of some retirement and disability insurance claims certain rights. 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 policy holders the right to appeal a claim denial.

ERISA requires insurance providers to accept or deny a claim in a timely manner, and explain why the claim was denied. This information can help you to file a strong appeal, if you can address the issues raised in the claim denial.

Can valid disability claims be denied over technical problems?

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 policy holders 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.

Applying for benefits can be a complicated process, and appealing that denial may be even more difficult. A skilled lawyer can help policy holders navigate the technical aspects of filing a disability claim, and can build the strongest case possible.

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.

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

What should I include in my Aetna disability claim appeal?

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.

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.

After appeals failed, some consumers have taken legal action against insurance companies to pursue compensation. In 2017, Unum faced a long term disability lawsuit after allegedly failing to pay a policyholder their benefits.