In this case, a policyholder was diagnosed with an aggressive form of skin cancer and had to undergo treatments. Due to the date of his policy renewal and the date of his treatments, the policyholder did not expect there to be any issue regarding his eventual claim when he had to file for disability. The severity of his cancer and the invasiveness of his treatments made it so he was unable to work and had to make a claim on his disability insurance policy with Aetna.
The first person to review the claim approved it, determined it did not fall under a pre-existing clause and pushed the claim to be approved. Someone higher up then overruled the decision and gave no explanation to the policyholder. A second time the claim was filed and someone else at Aetna looked at the claim, determined it did not fall under the pre-existing condition clause and moved for the claim to be paid. Again, someone higher up blocked the process and refused to pay the claim. Neither time was the policyholder given any explanation as to why their claim was being denied.
The policyholder then sought legal assistance and the case was taken to court. Thankfully, the court sided with the disabled claimant and found that Aetna’s decision to deny the claim for benefits was wrong. Aetna however, continued to try and justify its decision and claimed that it was a pre-existing condition and as such should not be covered by their policy. The Judge was not buying Aetna’s arguments and ruled in favor of the policyholder.
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