Aetna to appeal order on disability benefits

By Steve Korris | May 5, 2011

CHARLESTON - Aetna Life Insurance plans to appeal a federal court order finding it improperly denied disability benefits to former Bristol Myers Squibb manager Rickey Dickens.

CHARLESTON - Aetna Life Insurance plans to appeal a federal court order finding it improperly denied disability benefits to former Bristol Myers Squibb manager Rickey Dickens.

Aetna filed an appeal notice with U.S. District Judge Thomas Johnston on April 27, 30 days after he threw the case back at Aetna with heat.

He wrote that Aetna failed to explain why it disregarded a Social Security Administration decision in favor of Dickens.

"Aetna's cursory treatment of the SSA decision suggests an unfair decision making process, where it seems the long term disability plan administrator is merely going through the motions rather than appropriately considering the relevant evidence," he wrote.

He remanded the matter to Aetna to determine benefits internally.

Dickens, a senior territory business manager responsible for marketing drugs to doctors and hospitals, suffered depression, anxiety, and insomnia.

He applied to Aetna for long term disability, and he received benefits for four years.

Aetna terminated his benefits in 2008, finding he no longer suffered from injury or illness.

He sued in 2009, in Fayette Circuit Court, and Aetna removed the suit to federal court.

Dickens moved for summary judgment and Johnston granted it, finding the Social Security Administration continued to consider him disabled under relevant law.

He wrote that while Social Security awards are not binding on pension plan administrators, "SSA determinations are not worthless, either."

He wrote that when definitions of disability are similar, failure to consider an SSA award is an abuse of discretion.

He wrote that it was more difficult to show disability under Social Security's definition.

"Not only did Aetna fail to afford the SSA determination substantial weight, it ostensibly neglected to weigh the decision at all," he wrote. "Aetna's error regarding the SSA determination is severely compounded when juxtaposed with the fact that Aetna required plaintiff to initially apply for and fully appeal any denial of Social Security disability benefits."

He wrote that Aetna offsets its disability benefits by Social Security benefits.

"Aetna retroactively imposed the offset provision on plaintiff when he became eligible for disability benefits under the SSA," he wrote. "The fact that Aetna mandated plaintiff's application for SSA disability benefits and then financially benefited from the award of those benefits only serves to bring the fundamental unfairness of Aetna's actions into sharper relief."

Harry Bell of Charleston represents Dickens, along with Jeff Stewart and Robert Absten of his firm.

Grant Shuman and Joseph Garcia, of Spilman, Thomas and Battle in Charleston, represent Aetna.

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