In Your Corner: Disability Insurance Dispute

By Ryan Elijah

September 10, 2010 Updated Sep 10, 2010 at 10:15 AM EDT

Nearly 40 years after an accident, Jim Kjendalen's legs finally gave out on him in 2006. Despite Vocational Rehab, he could no longer work because of Osteoarthritis. He lost his job as an electronics technician and started collecting disability insurance from Aetna. But after 24 months, they re-evaluated his status and denied his claim.

"I knew it was going to change after that time frame, but I still qualify", said Kjendalen.

It's important to understand in a disability policy that after 24 months, there is a new set of criteria. The bar goes from being able to work in "your" occupation to "any" occupation.
Jim has 2 physicians that say his work would be limited to less than 2 hours of sitting and standing.
After receiving clearance from Jim, we spoke to Aetna at length about why the policy was denied. They detailed an extensive review process that included incomplete reports from Jim's doctors and gave us this statement.

Aetna Statement:
While Aetna is very sympathetic to Mr. Kjendalen's situation, our ruling was the correct one. Mr. Kjendalen's physicians, as well as independent medical experts who reviewed his case, agree that he is able to work in some capacity. Mr. Kjendalen was paid for two years of disability because he could not work at his previous occupation. Under the terms of his policy, a person must be unable to work in any job capacity to receive disability benefits beyond two years.

Aetna also hired a private investigator that recorded video of Jim shopping for an hour with his wife, but they never alleged Jim was fraudulent, just able to work at a number of companies in the area.

Jim disagrees and while he's on Social Security Disability, he feels he deserves the coverage his company paid for. Essentially, this comes down to the definition of "any" job.

"from their perspective I can work any job, but not from mine. I have doctors that have said I can't do any job", said Kjendalen.

With his appeals exhausted with Aetna, Jim felt we were his final option. He feels hiring an attorney would not be beneficial based on the amount he's owed, just over $30,000, which would cover him until he's 65.

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