Tennessee Resident Sues Aetna after Disability Benefits are Denied

Jerry Simmons of Tennessee has filed a lawsuit against his insurance provider, Aetna, over allegedly denying his long-term disability (LTD) insurance benefits without proper reason.

Simmons was employed by the Bristow Group as a helicopter pilot. This company maintained a group disability insurance plan, underwritten by Aetna. In April of 2012, Simmons quit work due to substance abuse issues and major depressive disorder. His depression was treated with a selective serotonin reuptake inhibitor or SSRI. Per the Federal Aviation Administration’s regulation, the use of SSRIs disqualifies pilots from flying.

Per the insurance plan, the first 36 months of disability insurance are contingent on a pilot being disabled if the FAA rules they are mentally or physically unfit to fly an aircraft. According to the disability insurance lawsuit, Simmons’s initial disability request was denied on the grounds that he was not receiving “effective treatment of alcoholism or drug abuse” that qualified under the rules of the insurance policy. The lawsuit asserts that during this time, Simmons was seeing a therapist regularly, but Aetna decided the visits were primarily to deal with the depression, not the substance abuse.

Simmons filed an internal appeal with Aetna in May of 2013, pointing out that irrespective of the substance abuse, his depression alone would make him eligible for his disability benefits under FAA regulations.

In July of 2013, Aetna sent Simmons a letter stating that they had denied the appeal. According to the lawsuit, their response focused exclusively on the substance abuse, and did not address SSRIs, the condition that disqualified Simmons for flight. The disability insurance lawsuit asserts that Simmons has exhausted Aetna’s appeals process, leaving only legal action as a means of getting his insurance benefits.

The lawsuit alleges that Aetna owes Simmons money for his long-term disability benefits, as well as alleged violations of Employee Retirement Insurance Security Act or ERISA, which governs LTD polices and other types of insurance.

The ERISA lawsuit seeks a payout of his disability insurance owed up to this point. The suit also seeks continued payment of disability insurance benefits per the plan, along with interest on the back-owed payments and attorney fees.

The ERISA lawsuit is formally titled Jerry Simmons v. Aetna Life Insurance Company, Civil Action No. 1:13-cv-00086, United States District Court, Middle District of Tennessee at Columbus.

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