SSA findings should be considered when deciding long-term disability benefits

Recently, a federal court ruled in favor of awarding an employee long-term disability benefits, but the insurance company that provided the long-term disability policy plans to appeal the federal district court’s ruling. The federal district court judge that heard the initial case found that the insurance company had failed to consider the Social Security Administration disability decision in favor of the employee when the company failed to award the employee long-term disability benefits.

The facts of the long-term disability case are based on a former senior territory business manager for Bristol Myers Squibb who was responsible for marketing various drugs to hospitals and doctors. The man suffered from depression, insomnia and anxiety. The man applied to the insurance company, Aetna, for long term disability and received long term disability benefits for four years. In 2008, Aetna terminated the man’s benefits citing that the man no longer experienced illness or injury.

The man sued in state court in 2009 but Aetna removed the case to federal court. The federal judge found that the Social Security Administration considered the man to be disabled and explained that even though Social Security decisions are not binding on the decisions of private insurance plan administrators, the findings of the Social Security Administration are also, “not worthless.”


Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.

The judge explained that the definitions of disability are similar between the long-term disability policy and the SSA, that it is more difficult to demonstrate disability under the SSA’s definition and a failure to consider the SSA’s findings is an abuse of decision-making power.

Source: The West Virginia Record, “Aetna to appeal order on disability benefits,” Steve Korris, 5/5/11


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