Free Affidavit - District Court of Connecticut - Connecticut

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I ’ I Case 3:03-cv-O1O€_]5WWE Document 7 Filed O4/(FS2004 Page 1 of 2
UNITED STATES DISTRICT COURT
DISTRICT OF CONNECTICUT
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AETNA LIFE & CASUALTY COMPANY : QQ Q `Y]
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Plaintiff, ; J1 §"'“““'
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: CIVIL NO. 3:03-CV-0l.r(i}:)2é%J;(W\]$[£)
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. MARCH 11, 2004 ,
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LASHAWN MILLS :
Defendant. ;
AFFIDAVIT OF DEBT
The undersigned being duly sworn hereby deposes and says:
I. I am the Overpayment Specialist Supervisor at Aetna Life and Casualty
Company.
2. Aetna Life and Casualty Company provided a Long Term Disability Plan
(hereinafter "Plan”) for the Defendant, LASI~IA\?\/N MILLS , which was in el`l’ect on or about
I November 27, 2000. This plan provided long term disability benelits to the employees ol'
Allegheny Hospital.
3. The Defendant, LASHAWN MILLS , was receiving long term disability beneiits w
under the Plan. Subsequently Aetna Life and Casualty Company discovered that the oeimiiitiie, l
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. Case 3:03-cv-0102+9/VWE Document 7 Filed O4/Q5!2004 Page 2 of 2 1
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LASHAWN MILLS , had also been awarded Social Security Benefits. This is considered other
income under the Plan. Plan benefits are subject to adjustment in the event that recipients are
i receiving income from other sources such as Social Security Disability Benelits.
l 4. As a result of the Social Security Benefits, an overpayment was made to the
Defendant, LASHAWN MILLS , in the amount ofTWELVlE THOUSAND FIVE llUl\lDRl*£ D
FORTY AND 18/100 ($12,540.18) DOLLARS. I
5. The Defendant, LASIIAWN MILLS , signed a Reimbursement Agreement \
promising to repay any and all overpayments of Disability Benelits. l
6. Despite demand, the Defendant, LASI-IAWN MILLS , has failed to make any
payments on this debt.
7. The above faets"a)le true.
¤____,;fjl-·~·` '''' J C 1
ori Carlson
Overpayment Specialist Supervisor
For Aetna Life & Casualty Company
Plaintiff
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Subscribed. and sworn to betore me this day ot ll Cm , 2004
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