AETNA Healthcare - denied benefits - did not file within 60 days of termination - was not informed of termination

# 1 for May 12, 2002

Complaints.com received the following consumer message on May 11, 2002:

From: Email User

RE: AETNA Healthcare - denied benefits - did not file within 60 days of termination - was not informed of termination In 1995, I was placed on long-term disability by my employer, Verizon, with AETNA being my insurance carrier provider. In April of 2000, my LTD benefits were terminated. Please note: I was never informed of this termination in any way until late October of 2001.

Once I was made aware of the termination, I immediately filed an appeal for reinstatement of my LTD benefits in November of 2001 with the AETNA Appeals Unit. In March of 2002, I received a letter from AETNA stating that my appeal was denied due to "untimely filing." AETNA stated that because I had not filed my appeal within 60 days of the April 2000 termination, under ERISA law, my appeal would not be taken under review.

I would like to clarify that I was never informed of the April 2000 benefit termination in any way. It was only until 18 months later, in October of 2001 that it came to my attention that my LTD benefits were no longer in effect. During the 18 month time frame that my benefits were supposedly terminated, AETNA continued to pay my medical costs and never informed me in any way that there was a problem or that my LTD claim had been closed.

When I questioned an AETNA employee as to why this was, I was told that because it was not until an "audit" was done in October of 2001 did it come to light that I should not be on the "rolls." It was only at that time, when they realized their error, was I then informed of my LTD termination and said termination enforced.

I feel that AETNA's decision to uphold denial using the reasons given is extremely unjust, as well as highly unethical. If I had been aware of the termination in April 2000 in any way, I most certainly would have filed an appeal within the timeframe required.

As it was, due to lax recordkeeping on AETNA's part, I was never informed of the termination because quite simply, they weren't aware of it themselves for 18 months!

I would like my appeal for my LTD claim be reconsidered. I have provided all the proper current medical documentation to the Appeal Unit which supports my medical status. I honestly do not understand how AETNA can do this legally.