A Missouri disability lawyer filed a federal lawsuit in the District Court in Missouri against the Aetna Life Insurance Company (Aetna). The Plaintiff, Rosamaria P., worked at Ernst & Young, U.S. LLP (Ernst & Young). This employment allowed Plaintiff to be covered under Ernst & Young’s long-term disability plan, which was administered by Aetna.
In Rosamaria P. Vs. Aetna Life Insurance Company, Plaintiff filed a disability lawsuit to recover wrongfully withheld long-term disability benefits by Aetna.
Case Facts Against Aetna
Plaintiff worked for Ernst & Young and filed a claim for disability benefits in 2008. Aetna approved the claim for benefits, which began on or about February 3, 2009. Plaintiff has continued to be disabled and should still be receiving benefits as of this date. The provisions of the plan state that Plaintiff is entitled to a gross monthly long-term disability benefit of $6,035, all of which is non-taxable. At all times throughout this ordeal, Plaintiff has remained current in terms of all associated payments needed to receive the long-term disability benefits as stated in the plan.
Aetna deducts the amount of $2,236 for Plaintiff’s Social Security Administration (SSA) benefit, along with $1,118 each month for the benefits received by her children. However, the plan does not allow for Aetna to offset the SSA benefit because the Plaintiff still has to pay income tax on 85% of the SSA money and is not receiving 60% of her former gross income. Aetna continuously refuses to acknowledge the tax consequences of the income taxes paid by the Plaintiff to the Federal and state governments when considering its withholding of Plaintiff’s benefits. The plan also does not have language stating that Aetna can deduct the children’s auxiliary benefits.
Aetna Claims Overstatement And Reduces Benefits To Plaintiff
In February 2010, Aetna claims that it overpaid the Plaintiff in the amount of $47,626.80. As a result, Aetna is withholding future benefits until that sum is recouped. As of October 16, 2011, Aetna claims the overpayment is $20,816.80.
Missouri Disability Attorney Files Lawsuit Against Aetna
Plaintiff argues that Aetna owes her $41,539.61 in long-term disability benefits as of October 31, 2011. Plaintiff also argues that this dispute is governed by the Employee Retirement Income and Security Act (ERISA). However, Aetna has not treated this dispute as one that is governed by ERISA.
The lawsuit alleges that Aetna failed to provide the following to the Plaintiff:
- Appropriate notices of how Aetna arrived at its adverse benefit determinations
- Appropriate notice of whether Plaintiff has exhausted her administrative remedies or not
Plaintiff Seeks Following Relief From Aetna In This Lawsuit
Due to the actions of Aetna, Plaintiff requests the following relief to be granted by the Court:
- A judgment against Aetna that prevents Aetna from taking any offsets against Plaintiff’s monthly benefit payments
- A judgment against Aetna that requires Aetna to pay back all wrongly withheld benefits through the date of judgment
- A judgment against Aetna to pay all accrued interest on those withheld benefits
- A judgment against Aetna requiring Aetna to pay the full monthly benefit to the Plaintiff
- A judgment that clearly defines the rights of each respective party under the insurance contract
- A judgment against Aetna requiring it to pay for court costs and attorney fees
- A judgment that requires Aetna to pay all other relief that the Court declares to be proper and just