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Cigna Denies Disability Benefits, But Additional Information Could Have Resulted In A Victory

When filing a disability application or appeal it is of the utmost importance to provide the insurance company all of the relevant medical records and/or documentation supporting your disability in a timely manner.

If you fail to submit any important documents or records they will not be considered by the judge at a later date if your disability claim is denied.

This is why it is very important to have a disability lawyer guide you through the appeals process in order to determine what documentation must be submitted to ensure the administrative record is complete. You only get once chance to submit a good appeal.

Illustrating this very situation is a recent decision by The United States District Court for the Eastern District of Louisiana, where the judge ruled in favor of Life Insurance Company of North America’s (LINA) Motion for Summary Judgment.

In that case, the Plaintiff was involved in a work-related car accident injuring his neck and back. He attempted to return to work, however the pain was too great and his physicians agreed he should apply for long-term disability benefits. LINA reviewed the Plaintiff’s application for benefits as well as his medical documentation and denied his claim stating that he “lacked positive clinical measurements to support a degree of functional impairment that would prevent him from returning to work in his regular occupation.”

After his claim was denied, the Plaintiff applied to the Social Security Administration (SSA) for disability benefits with the help of his Louisiana disability attorney. Around the same time, the Plaintiff notified CIGNA that he wished to appeal their decision and submitted additional documentation in support of his disability, however, neither Plaintiff or his attorney ever informed Cigna of the pending SSA benefits application or the later decision by the SSA to approve his disability benefits.

Cigna denied Plaintiff’s ERISA appeal due to the lack of objective medical evidence and did not consider the SSA decision as they were never made aware of it. The Plaintiff declined LINA’s offer to file a voluntary administrative appeal and instead filed and ERISA lawsuit. Realizing that he had neglected to provide LINA with the SSA decision, the Plaintiff submitted the SSA decision as a part of his trial exhibit list.

The district court ruled that the SSA decision was not part of the administrative record and could not be considered.

Louisiana Federal Judge Agrees with the Cigna Denial of Disability Benefits

The court of appeals affirmed the lower court’s decision stating that: “The administrative record consists of relevant information made available to the administrator prior to the Complainant’s filing of a lawsuit and in a manner that gives the administrator a fair opportunity to consider it.” The Plaintiff had ample opportunity to supplement the administrative record with the SSA’s decision as he filed the lawsuit nearly 18 months later. Failing to provide this information to LINA before filing the lawsuit was inexcusable and therefore, the Court agreed that the SSA’s decision was not part of the administrative record and denied Plaintiff’s request to remand his case back to CIGNA for further review.

Lesson to Be Learned from this Cigna Disability Denial Lawsuit

The important lesson that can be taken from this case is that any pertinent information a claimant would like a judge to consider in any future case against their insurance company  for disability benefits MUST be submitted in a timely manner before his or her administrative record is closed.

Disability cases can involve thousands of pages of medical records and other pertinent documents. All of the documents need to be carefully reviewed to determine which documents are relevant and which are not. Once the administrative record is closed, and a disability denial lawsuit is filed, no additional information can be considered.

This is why it is extremely important to hire effective counsel to represent you who specialize in disability income claims to ensure that your administrative record is complete and that you do not end up in the same predicament as the Plaintiff described above.

Contact us for a free consultation to discuss your disability claim, denial, appeal, or lawsuit.