David C. Pellegrin
Court Finds Aetna Erred in Denying Long-Term Disability Benefits to Software Management Engineer
Published by The Pellegrin Firm December 26, 2020
A federal district court in California recently found that Aetna erred in denying long-term disability benefits to a Software Management Engineer employed by Jet Propulsion Laboratory, a federally funded research facility owned by NASA and managed by California Institute of Technology (Caltech). The insurance policy at issue was sold to Caltech and insured by Aetna. Because the insurance was sponsored by a private employer, the court decided the claim under a federal law, the Employee Retirement Income Security Act (“ERISA”). Plaintiff’s occupation required her to work long-hours, managing and adapting software in time-sensitive and safety-sensitive environments. By any measure, this is a job that requires sharp cognitive skills.
The court found under a de novo standard of review that Aetna was wrong to find that plaintiff’s fibromyalgia, cognitive fatigue syndrome, mast cell activation syndrome, and behavioral issues did not preclude her from working in her occupation. The plaintiff, after retaining counsel, submitted statements from her husband and co-workers, as well as neuropsychological testing. The court found Aetna’s retained doctors were wrong to discount subjective symptoms when fibromyalgia and chronic fatigue do not generally produce symptoms testable by objective tests. Further, those doctors did not give significant weight to those aspects of plaintiff’s conditions which are testable. Advanced neuropsychological tests designed to detect malingering found the plaintiff to be significantly psychologically and cognitively impaired. Also, tests showed elevated histamine levels, which are consistent with mast cell activation syndrome, symptoms of which include fatigue and cognitive problems.
The court ultimately found the plaintiff’s treating doctors to be more convincing than Aetna’s retained doctors. Only one of Aetna’s doctors even considered cognitive limitations, which in the court’s opinion were the most relevant to determining whether plaintiff could continue to perform her own occupation. The court awarded back benefits and ordered Aetna to pay benefits for at least the remainder of the policy’s two-year own occupation period. The court set deadlines after Christmas for the plaintiff to move for her attorneys’ fees under ERISA. The case is Myers v. Aetna Life Insurance Company, No. CV 19-9555 DSF (KSx), 2020 WL 7423109 (C.D. Cal. Dec. 17, 2020).