By Scott E. Davis, Disability Attorney
Case Study: Carrier vs. Aetna Life Ins. Co., 2015 U.S. DIST. Lexis 97693
Gloria Carrier previously worked for Bank of America and through her employment, the bank provided disability benefits to its employees through a fully insured disability policy with Aetna Life Insurance Company.
After being diagnosed with cancer, Ms. Carrier underwent surgery and chemotherapy which eventually led to neuropathy (nerve damage) and she also became depressed. As a result, Ms. Carrier took a leave of absence and submitted a claim for short term disability benefits which was granted, and after those benefits were exhausted, she began receiving long term disability benefits from Aetna.
However, after paying benefits for less than a year and half, Aetna terminated her long term disability benefits after concluding that she no longer met the policy’s definition of disability.
Dr. Corrado had repeatedly supported Ms. Carrier’s claim but Aetna’s doctor did not – as insurance companies often do, Aetna agreed with its own doctor and denied her claim.”
Aetna based its termination of benefits on the review of one of its doctors who reviewed only Ms. Carrier’s medical records and who had a telephone call with one of her treating professionals, neuropsychologist, Philip Corrado, Ph.D. Dr. Corrado had repeatedly supported Ms. Carrier’s claim but Aetna’s doctor did not – as insurance companies often do, Aetna agreed with its own doctor and denied her claim.
Ms. Carrier appealed the decision and submitted additional evidence which proved she was cognitively unable to do her job and that she also suffered from chronic pain. In response, Aetna again obtained several medical records only reviews from its doctors who disagreed and opined she had no limitations and was able to work.
Aetna’s use of medical professionals to review a disability claim is hardly surprising and nothing new. I have written a number of articles referencing that this tactic is often the disability insurance company’s favorite tool to deny a legitimate claim. The insurance company makes it appear as if you obtained a full and fair review because their medical professionals reviewed your claim and made a decision, but that is hardly the case as the insurance company’s medical professional frequently agree with the insurance company who hires them.
Ms. Carrier’s medical professional had actually examined her, interviewed and run extensive testing on her and opined she was disabled. The insurance company’s medical professional who had never seen her, not surprisingly found she had no problems and could return to her work.
Thus, as often occurs in disability claims, the court had a good old fashioned dispute between medical experts with completely opposite opinions about Ms. Carrier’s ability or inability to work. Ms. Carrier’s medical professional had actually examined her, interviewed and run extensive testing on her and opined she was disabled. The insurance company’s medical professional who had never seen her, not surprisingly found she had no problems and could return to her work.
Fortunately for Ms. Carrier, as referenced, Dr. Corrado had performed extensive and objective neuropsychological testing with her that proved she had significant cognitive limitations which precluded her ability to perform her work. In addition, Dr. Corrado had consistently opined that based on his treatment Ms. Carrier and this cognitive testing, she was unable to work in her prior job. Thankfully, the judge agreed with Dr. Corrado and found that Aetna was wrong when it terminated her benefits.
Practice Tip: The important practice tip to learn from Ms. Carrier’s case is the following – if you have a disability claim based entirely or in part on problems with cognitive (brain dysfunction)(i.e. problems with memory, concentration, focus, brain speed and processing), it is important to undergo objective testing with a neuropsychologist who has specialized training to evaluate not only your psychological diagnoses and limitations, but also they can administer neuropsychological tests as occurred in Ms. Carrier’s case, which provide an objective measurement of whether you are cognitively impaired, to what extent, and most importantly, whether these impairments/limitations preclude you from working in your prior occupation and potential, from working in any occupation.
© 2015 Scott E. Davis, Disability Attorney