A plaintiff filed suit last Friday in the District of New Jersey against his insurance company, Aetna Inc. and Aetna Life Insurance Company. The action, which was filed under the Employee Retirement Income Security Act of 1974 (ERISA), comes after repeated denials by the defendant to cover the plaintiff’s medical expenses, which he claims he is entitled to under his insurance policy with Aetna.
After noticing the presence of a rash covering his whole body, the plaintiff sought out medical attention for what he presumed to be eczema. Following two biopsies, he was diagnosed with stage III CTCL-MF, or Mycosis Fungoides. Mycocis Fungoides (MF) is “a rare form of blood cancer also called cutaneous T-cell lymphoma.” The symptoms of Mycosis Fungoides include weight loss, redness, itching, and an overall burning sensation on one’s skin. MF has a median survival rate of four to six years. A recent article detailed that a five-year survival rate for a patient with this type of cancer is only 16%.
Following his diagnosis, the plaintiff’s doctor placed him on a chemotherapy regimen, which he is still on. The plaintiff has an insurance policy with the defendant called the Critical Illness Plus with Cancer with Recurrence, a policy to which both he and his employer have paid the necessary premiums. The defendant’s policy provides a fixed dollar benefit for covered expenses up to $40,000. The complaint specifies that “the policy makes clear that an insured…with this type of invasive...
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