According to court documents, the plaintiff did receive a Social Security disability award even though the Fifth Circuit Court affirmed a lower court ruling that Aetna did not abuse its discretion under ERISA by denying the plaintiff her disability payments.
The woman at the center of the case has cancer, and akin to any similar Idaho Wrongly Denied Disability Claim against Aetna or other insurers involved with Idaho LTD, the plaintiff holds that Aetna erred in terminating her benefits under provisions guaranteed under ERISA.
Aetna petitioned for summary judgment, and the district court hearing the case granted Aetna’s motion based on what was described as substantial medical evidence supporting the Plan administrator’s decision to deny benefits, together with the award from the Social Security Administration (SSA). Evidence introduced suggested that the plaintiff’s condition improved following the SSA determination. Thus, Aetna’s decision to deny benefits was not, in the district court’s view, improper. The Fifth Court upheld that finding, and so far the State Supreme Court will not hear a further appeal.
That said, there are underlying issues at play not just affecting Idaho LTD Aetna cases or Idaho Long Term Disability fraud insurance alleged to be fraudulent or involving bad faith. The Idaho Statesman (8/28/14), writing from the McClatchy Washington Bureau, notes a concern with regard to a depletion of reserves couched within the SSA disability insurance program. Assuming current funding levels, reserves are expected to begin dipping into the red by 2016 with incoming revenues funding about 80 percent of liabilities within the program.
How this pressure will impact decisions with regard to SSA disability claims going forward is not clear. But given that the funding deficit has been going on since 2005 with no changes in funding to stem the bleeding, it seems apparent that a solution is not on the immediate horizon.
“While legislation is needed to address all of Social Security’s financial imbalances, the need has become most urgent with respect to the program’s disability insurance component,” trustees said in the report. “Lawmakers need to act soon to avoid automatic reductions in payments to DI beneficiaries in late 2016.”
While Social Security is a national program, how will this pressure impact Idaho Wrongly Denied Disability claims going forward? Will insurers such as Aetna and others involved in Idaho LTD coverage, including Unum and Mutual of Omaha, prove sympathetic to claimants in dire need of disability benefits in light of the sagging fortunes of Social Security?
Or will private insurers such as Cigna or Northwestern Mutual take a cue from the Fed’s flagging management of Social Security and suggest, sorry, but there are similar pressures on our reserves as well, requiring similar denials of otherwise legitimate claims?
Will this be the launching point for the typical Idaho bad faith insurance lawsuit going forward? Time will tell. But one thing is clear. It’s tough out there, and any insurance company beholden to its shareholders will always be seeking relief from paying claims, as unfair as it might be. Thus the need to consult a skilled Idaho long-term disability fraud insurance attorney, for best practices, when your Idaho LTD claim is denied. Chances are it will be denied in the first go-round. They almost always are.
Akin to knowing specifically why your claim is denied, is appreciating the market and funding pressures driving the Idaho Wrongly Denied Disability Claims.