If you aren’t employed in a dangerous line of work, you may not think that long term disability insurance coverage is something that you’ll ever need. However, the majority of long term disability claims aren’t related to the job at all. Aetna benefits, for instance, are meant to make up for “some” lost wages “if you become injured or sick and can’t work.”

What Are the Aetna Benefits for LTD Insurance?

The specific benefits offered by Aetna vary from policy to policy. There are some commonalities, however.

If your long term disability claim is approved, Aetna benefits cover a portion of your lost wages which it pays out on a monthly basis. The amount offered depends on your usual earnings and may be reduced by any other sources of disability earnings, like workers’ compensation.

In general, Aetna benefits for those covered by long term disability coverage also vary depending on the specific circumstances of the claimant. For instance, older claimants are more restricted in how long they can claim benefits.

Long term disability plans offered by Aetna cover up to roughly 67% of your earnings or up to $10,000 in benefits monthly. Both of these amounts are only offered through expanded plans. Standard benefits of some plans max out at 60% of earnings or $8,000.

Aetna also offers the services of a Work Solutions Program Team who can work directly with your employer and health providers, to assist when you are ready to return to work. This team is meant to help policyholders understand and follow their doctor’s orders in order to ensure that the claimant can return to work as soon as possible. If the policyholder is no longer able to return to their original position, Aetna benefits also include training for a new job.

How Much Does Aetna Insurance Cost?

The cost of Aetna coverage differs depending on what coverage you want and how much you are paid in salary or wages.

According to Insure.com, most long term disability plans cost more than $2,000 per year. Usually, the cost falls between 1 and 3% of your total salary. However, factors like the policyholder’s age, health, gender, smoking status, and where they work can also impact how much is paid.

Policies that cover less are also likely to be less expensive. This means that choosing a policy with a more specific definition of disability could save you money, but it could also mean your situation isn’t covered if you one day need to make a claim.

How Long Does Aetna Long Term Disability Last?

Aetna benefits are offered for up to five years or until the claimant reaches retirement age, depending on the situation. The amount of time that benefits are offered also depends on whether or not the claimant’s disability led to hospitalization.

For instance, Aetna offers a 90-day extension of benefits if a claimant is confined to a hospital for a time. The coverage itself, theoretically, lasts as long as you pay for it. This means that one policyholder may need to file more than one claim for disability benefits.

How Is Aetna Eligibility Determined?

Just because Aetna benefits are offered by your employer doesn’t mean that getting long term disability benefits will be easy or even simple. In the most basic terms, disability coverage should come into effect any time a policyholder becomes unable to work; however, the reasons for that inability to work matter for whether or not your claim will be approved.

The first step to determining whether or not you’re eligible for coverage is to consult your policy’s definition of disability. Aetna provides definitions for two types of disability: long term and short term disability. Long term disability is defined as “an illness or injury” that causes an individual to not “be able to work for a long time”. This inability to work may not include all types of work but rather just the type of work done in your current position.

According to Disability Secrets, the main hurdle you need to overcome to prove your eligibility for Aetna benefits for long term disability is a judgment by your treating doctor. As a part of your application for coverage, your doctor will need to complete a form or make a statement on your condition. You will also need to provide medical records to prove that your injury or illness is objectively provable.

To be eligible for coverage, claimants must be full-time workers, can’t have been treated for a preexisting condition within a few months of filing, and must wait through an “elimination period” before coverage begins. There are also exclusions for disability caused by alcohol or drug use, including use that results in a car accident.

Those suffering COVID-19 symptoms leading to a disability claim may have different paperwork as well.

Aetna Disability Appeals Process

If your Aetna disability claim is denied, the company says that you can ask for a review of your claim. The appeals process can be initiated one of two ways: by phone or mail.

Aetna provides a complaint form online that can be mailed. Appeals must include the following information:

• Name
• Employer or sponsor name (group name)
• Member ID number
• Additional information supporting the appeal

The deadline to appeal a denial is generally 180 days from when the claimant received notice of the denial; however, some plans have different timelines, says Aetna, that are available in the Summary Plan Description.

The length of time it will take Aetna to respond to an appeal depends on state law, if the appeal is urgent, and if the disability insurance plan offers more than one level of appeal.

Claimants are also entitled to an external review of their denied disability claim once the appeals process is exhausted, notes Aetna’s website. Under Aetna’s External Review Program, the denial may be reviewed by an independent physician. The external review process takes approximately 30 days, says the insurer. To initiate the review, the claimant must complete the External Review form included with their appeal denial letter.

Experts say that prior to initiating the appeals process with Aetna, claimants should consider contacting an experienced disability attorney. Complicated claims are easier for insurance companies to deny, as are incomplete applications. In addition, a lawyer can help ensure that Aetna is following the proper procedures.

Get Help With Your Long Term Disability Insurance Appeal

If you filed a claim for long term disability insurance benefits and your claim was denied or terminated, the attorneys working with Top Class Actions can help you file for an appeal against the insurance company, which will help increase your chances of a successful appeal. 

You may also qualify for help if you are just beginning the application process or if you have already filed your appeal and haven’t received a denial letter.

Fill out the free form on this page for more information. 

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