Tennessee Resident Sues Aetna after Disability Benefits are Denied

Per the insurance plan, the first 36 months of disability insurance are contingent on a pilot being disabled if the FAA rules they are mentally or physically unfit to fly an aircraft. According to the disability insurance lawsuit, Simmons’s initial disability request was denied on the grounds that he was not receiving “effective treatment of alcoholism or drug abuse” that qualified under the rules of the insurance policy. The lawsuit asserts that during this time, Simmons was seeing a therapist regularly, but Aetna decided the visits were primarily to deal with the depression, not the substance abuse. 

Simmons filed an internal appeal with Aetna in May of 2013, pointing out that irrespective of the substance abuse, his depression alone would make him eligible for his disability benefits under FAA regulations. 

In July of 2013, Aetna sent Simmons a letter stating that they had denied the appeal. According to the lawsuit, their response focused exclusively on the substance abuse, and did not address SSRIs, the condition that disqualified Simmons for flight. The disability insurance lawsuit asserts that Simmons has exhausted Aetna’s appeals process, leaving only legal action as a means of getting his insurance benefits. 

The lawsuit alleges that Aetna owes Simmons money for his long-term disability benefits, as well as alleged violations of Employee Retirement Insurance Security Act or ERISA, which governs LTD polices and other types of insurance. 

The ERISA lawsuit seeks a payout of his disability insurance owed up to this point. The suit also seeks continued payment of disability insurance benefits per the plan, along with interest on the back-owed payments and attorney fees. 

The ERISA lawsuit is formally titled Jerry Simmons v. Aetna Life Insurance Company, Civil Action No. 1:13-cv-00086, United States District Court, Middle District of Tennessee at Columbus. 

If you or someone you care about was wrongfully denied long-term disability insurance benefits from an insurance company like Aetna or Unum, you probably feel overwhelmed. Dealings with large bureaucracies like insurance companies has a way of making you feel powerless. But you need to remember that you have rights, and there are steps that you can take to regain control over your situation. 

You can start by visiting the Unum/UnumProvident Disability Insurance Claim Denial Class Action Lawsuit Investigation. Here, you can enter information about your case for review by a legal expert with a background in this type of litigation. This initial consultation is free of charge. From here, you can receive additional guidance on the best steps to take in your exact situation.