ST. LOUIS – A motion to dismiss filed by Aetna Life Insurance stemming from the company's denial of a former Boeing Corp. employee's claim for short-term disability (STD) and long-term disability (LTD) benefits has been granted by the U.S. District Court for the Eastern District of Missouri.
The court concluded that plaintiff Tiffany Ausler's denial-of-STD-benefits complaint is time barred and that she failed to exhaust her denial-of-LTD-benefits claim.
The court order was issued by U.S. District Judge John Ross.
According to the March 4 court filing in Ausler v. Aetna Life Insurance Co., Ausler, a Boeing employee for more than 13 years, submitted a STD and LTD claim in December 2014 to Aetna, Boeing's service representative for the benefits plan. Ausler's claim was denied by Aetna which argued that evidence did not support disability as defined by the plaintiff's group policy.
After her appeal was denied by Aetna in February 2015, Ausler filed a lawsuit alleging Aetna's denial "was an abuse of discretion" and that language in the plan brochure "is ambiguous," the ruling states. Aetna argued the plaintiff did not comply with the required 180-day time frame to have a right to dispute the denial legally.
Aetna also argued that Ausler is "barred from advancing her denial-of-LTD benefits claims" due to her failure to "exhaust the procedure outlined in the plan brochure."
However, Ausler claimed there was an "unreasonably short" time limit to legally dispute the claim and file legal action. She further argued that the 180-day time limit only applied to eligibility claims.
Ross found that there "are multiple instances in which the plan brochure's plain language unambiguously shows the 180-day deadline is not limited to eligibility claims," the ruling states. The judge also ruled that "180-days is a sufficient amount of time to investigate and file" a denial of benefits under the Employee Retirement Income Security Act.