Santa Clara, CAAetna Life Insurance Co., is facing a long-term disability denial lawsuit brought by policy holder who had her long-term disability benefits denied, despite being qualified.
Holly Kmita, a former sales manager for Shadow Ridge Marriott Vacations Worldwide Corp., alleges in her complaint, that after becoming disabled in 2016 she applied to Aetna Life for disability benefits. While she was approved for short-term benefits, the insurer denied her long-term claims, despite qualifying as being disabled by the policy criteria.
Disability insurance is meant to provide peace of mind to policyholders that, should they somehow become sick or injured and unable to work, will provide a portion of their pre-disability earnings to help them make ends meet.
Long-term disability plans typically begin providing benefits after around six months of illness or injury, and provide the insured with between 60 and 80 percent of their pre-disability earnings.
Insurance companies are required to pay out all legitimate claims in good faith. This means the claim must be adequately investigated, and paid in a timely manner. If companies unreasonably deny or delay payment of claims to protect profits or meet quotas, they may be acting in bad faith. If companies fail to properly investigate a claim, not provide benefits as laid out in the policy contract, or not adequately inform policyholders of the terms of their policy (including changing the terms without adequate notification), policyholders may be able to file a lawsuit against the insurance company to have the decision reversed.
According to the Kmita, in denying her long-term disability claim, Aetna is in violation of the Employee Retirement Income Security Act (ERISA).
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