Opinion ID: 752912
Heading Depth: 2
Heading Rank: 5

Heading: Aetna's Response to the Request for Reconsideration

Text: 21 On December 11, Elliott responded to Ace's request. His letter stated that the information submitted by Ace had been reviewed by Aetna's medical consultant who had advised that there is no objective medical evidence ... to support your contention that you are unable to work at any gainful occupation. It reiterated that to receive benefits you must be totally disabled ... from working at any gainful occupation. The letter advised Ace that for Aetna to review her file, Ace would have to have her physicians furnish ... objective medical evidence to support [her] contention [of total disability]. Aetna's policy neither contains nor defines the term objective medical evidence, and it did not inform Ace what would qualify as objective medical evidence; its claim handling guidelines, moreover, instruct analysts to consider subjective complaints of pain even in the absence of objective medical findings. 11 22 Southall testified that he was uncertain whether Ace's documents contained objective medical evidence and that he would not be surprised if a claimant did not know whether a physician's letter constituted objective or subjective evidence. He stated that what he wanted to see was Dr. Kiessling's chart notes, reports of examinations, and x-rays, but he never asked Ace or Dr. Kiessling to supply these materials. 23 Aetna's medical consultant, Dr. Galvin, again reviewed Ace's file and concluded there was no medical evidence to support Dr. Kiessling's opinion that Ace was in the Class V disability category. At trial, however, he conceded that Dr. Kiessling's letter contained objective medical evidence and that he was unable to ascertain from Ace's file whether she was disabled. 24