Judge John Ross of the U.S. District Court for the Eastern District of Missouri concluded Aetna’s denial of plaintiff Tiffany Ausler’s short-term and long-term disability benefits is time barred, and Ms. Ausler failed to exhaust her claim.
Aetna, Boeing’s administrator for the benefits plan, denied Ms. Ausler’s claim in December 2014, stating that she failed to provide information that aligned with Aetna’s definition of disability. Ms. Ausler appealed the decision in February 2015, and after that was denied, she sued the insurer.
While Ms. Ausler’s lawsuit argued Aetna’s language in its plan brochure “is ambiguous,” Aetna claimed Ms. Ausler didn’t follow the insurer’s 180-day deadline to dispute the denial. Mr. Ross sided with Aetna, finding “multiple instances in which the plan brochure’s plain language unambiguously shows the 180-day deadline is not limited to eligibility claims,” according to the ruling, cited by the St. Louis Record.
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