Aetna sued for 'acts-of-war' exclusion, denying Army vet PTSD coverage

Aetna is facing a federal lawsuit from an Army veteran who claims the insurance company was wrong to use an "acts-of-war" exclusion to deny coverage for his post-traumatic stress disorder (PTSD) after his service in Iraq.

After returning from a 2008 deployment, Jerico McCoy applied for short-term disability benefits from aetna to treat his symptoms of depression, anxiety, nightmares, flashbacks, chronic fatigue, insomnia, irritability, short-term memory loss and hyperarousal, Courthouse News reported. The claim would have provided McCoy with his full salary of $1,056 a week during an unpaid medical leave granted by his employer.

However, aetna denied McCoy's claim, citing a clause in his benefits coverage that says disability benefits are not paid "for a disability resulting from acts of war, participation in a riot, insurrection, rebellion or civil commotion," according to The Oregonian.

McCoy then appealed the decision, and aetna agreed to pay his short-term disability benefits for only two months. The insurer later reversed that decision too and returned to its original denial, questioning the depth of McCoy's disability and claiming he didn't produce enough medical evidence to support his allegations.

In his lawsuit against aetna, McCoy alleges Iraq was a sovereign nation and, therefore, not at war with the United States during his deployment there, reported the Associated Press. "War, both declared and undeclared, requires a conflict between two nations. War cannot exist between mere individuals," according to the lawsuit.

Forrest Millikin, McCoy's attorney, likened the Iraq situation in 2008 to U.S. troop occupations of friendly nations, such as Germany and Japan. If a veteran suffered an injury in such a place, insurance companies wouldn't consider it an act of war, he told The Oregonian.

To learn more:
- read the aetna lawsuit (.pdf)
- read The Oregonian article
- see the Associated Press article
- check out the Courthouse News article

Related Articles:
Aetna sues surgery centers for overbilling
Michigan Blues wants aetna antitrust lawsuit dismissed
Aetna sues Michigan Blues for artificially raising market rates
Docs sue Horizon Blues to prevent network termination
Anthem 'excessive' rate hike lawsuit heads to state Supreme Court
Highmark sued for reimbursing contraceptives