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Worker's disability denial affirmed at 7th Circuit

July 31, 2012

A former worker whose degenerating discs and spondylolisthesis caused her to no longer be able to work as a sales rep for AstraZeneca was not improperly deprived of benefits when the insurer terminated them.

The 7th Circuit Court of Appeals affirmed the decision of the District Court for the Southern District of Indiana in favor of the defendants in Carol Aschermann v. Aetna Life Insurance Company, et al., 12-1230. The appeals court held that Aetna and defendants had not acted in an arbitrary and capricious manner when Lumbermens Mutual Casualty Co. terminated disability benefits that Carol Aschermann had been collecting between 2003 and 2009.

Aetna claimed that Aschermann submitted outdated tests and medical information in submitting a claim for continuation of benefits; Aschermann claimed she could work no more than four hours a day even at a sedentary job.

“The statement that existing records were outdated, coupled with a request for new diagnostic tests, gave Aschermann a ‘reasonable opportunity’ to supplement the file and receive a ‘full and fair review’ within Aetna’s bureaucracy,” Chief Judge Frank Easterbrook wrote for the panel. “Honesty is a virtue, not a problem. Given the record that Aetna evaluated, its decision was not arbitrary or capricious.”

 

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