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CIGNA Disability Claim Denial: A Claimant’s View

Every day disability claimants around the country contact our disability attorneys about a CIGNA disability claim. Many individuals tell us similar stories about the manner in which their CIGNA disability claim has been handled.

We wanted to share with you a recent comment that was posted on our website about a CIGNA denial:

From: Laura S.

It saddens me to hear all the stories of individuals who worked and in the time of need were denied benefits by the company, CIGNA (who has been well compensated for their services many times over the amount of our claims) due to an uncontrolled life changing event.

I thought I was alone and that I had done something wrong. I have complied with everything CIGNA has asked from me and I to have been denied because my Dr., according to CIGNA’s medical team, did not include the “information they are looking for”, CIGNA’s words not mine.

I was told to wait for the denial letter so I can present it to my Dr.s so they can see why I was denied and why I’m not getting paid. This was 2 weeks ago and no letter yet. I have been calling and unable to get anyone to speak to me. According to the Rep, the letter was going out on March 23 and no letter yet. In the mean time I have been without pay since Feb. 21 and that check was only for $217.00. According to CIGNA my application for supplemental social security benefit paperwork was not turned in (I have sent in paperwork 3 times) so they only paid there part which was $217.00, not even enough to pay my light bill.

I had multi level Anterior Cervical Decompression and Fusion to C3/C4 C4/C5 C5/C6 on June 24, 2011 and have not been able to recover. Suffer from pain to shoulders, neck, back, numbness and tingling to fingers, daily migraines and my vision is progressively getting worse since surgery (20/20 vision prior to surgery). Unable to drive, I am unable to turn due to extremely poor range of motion to left side and new procedures have caused extremely poor range of motion with pain, popping and spasms to the right side.

Referral for PT by Neurosurgeon after surgery caused so much pain and spasms that physical therapist had to stop therapy because the spasms were so strong he was unable to work with me and was afraid to injure me further. He then referred me to a Pain management Dr. for Epidural Steroid injections to get rid of pain so I could continue my PT, that was an even worse recommendation. The injections have left me with more pain and less range of motion. The PM Dr. explained to me that my facets were damaged already due to deterioration and that the first two injections did not work because the lower end of the surgery side (Cervical area) is completely closed from scar tissue not allowing the medication to enter the pain inflicted areas. They then had to bypass the scar tissue going up higher and that has been the worse decision ever.

With no pay and no medical insurance (can not afford COBRA fees, still trying to find a way to pay it before period ends) I can’t see the Dr. for further evaluation. I’m glad I’m not alone and I’m extremely happy that I am not crazy. I am at the end of my rope and out of ideas.

To CIGNA, from all of us who suffer due to your injustice and lack of compassion, it’s not about the money for us who go to bed in pain and wake up with pain that never goes away, those of us who pretend everything is fine so that our children and family don’t worry, those of us who on top of the pain have to worry about what will I feed my family today, will my kids be able to bathe tomorrow or will they disconnect my water, will my children be able to see their homework or will they disconnect my light, those of us who can’t sleep due to the pain but more because of the fear of losing our home, or worse worrying about if something happens to us who will take care of our children and those of us unable to carry our baby, hug our children, play with our dog, run with our best friend, go to work, go on a date. What we want is the benefits that we have already worked hard for to pay so that we can continue to afford medical assistance who, God willing, will eventually lead us to a full recovery or close to it; but most of all, CIGNA, we want to be able to provide at least the basic necessities to our children/family. The only luxury I ask for is my health, if I have my health I get my life back. We are not about the bottom line, we are about family, good health and good quality of Life.

Sincerely,
Human Being (in case you were not aware of that) Mother’s, Father’s, Son’s, Daughter’s, Grandparent’s, Uncle’s, Aunt’s, Friend’s…

There are 50 opinions so far. Add your comment now.

Attorney Greg Dell:

Laura,

Thank you for sharing your thoughts about CIGNA. I know that CIGNA reps read our website so I am sure they will hear your message loud and clear. You need to file a timely appeal in response to CIGNA’s denial. Make sure you send in as much medical support as possible. You need to do whatever you can to get documented medical support so that you can win your claim.

Linda Harris-Boyd:

In response to Laura,

CIGNA did the same thing to me. I was paralyzed from my cervical disc surgery on my left side of my body from head to toe and numb from head to toe on my right side. CIGNA denied me and I received nothing. I almost lost my mind. I was already traumatized by the paralyzation, but to have what I paid into for years to help me incase anything went wrong deny me my benefits openly and I could do not about it almost sent me over the edge.

I found them with every inch of my will, but I had to have another surgery because the first surgery was not successful so they had to remove and redo the surgery and put a cordaber bone in my cervical disc. I had to learn to walk all over again. Still CIGNA denied me against my doctors. All specialist in their orthopedics. The doctors sent many letters informing CIGNA that I was incapacitated. I am still partially paralyzed on my left side of my body and numb from under my breast to the tip of my toe on the right side of body.

CIGNA got away with not paying me my money. They used a nurse practitioner to go against my surgeons. Also, those people that made a decision on my case worked for CIGNA in some capacity. I saw the signatures.

Although, I fought a good game with them. My doctors informed me that I could not continue to stress because I could not heal. They took my money for years and did not follow through on their end of the contract. It should be a law against these thieves. If I can do anything to help anyone, please let me know. I will help in anyway that I can. They are not people of GOD!

Laura, I too am someone and I hope that you can receive your money. I lost everything because of them. I am just trying to get myself back to some normality in the finance department because I got nothing.

Jil S.:

You are not alone Laura.

I am going though the exact same thing. I did receive the SSDI within 4 months (didn’t take THEM long to see it) yet here we are more than a year since I left work, and CIGNA continues to deny… appeal after appeal.

You give me courage to continue to fight.

I have friends in the HR industry who have chosen other providers after hearing so many of these things about CIGNA. My hope is that one day they all will hear and CIGNA won’t have any policy holders left to deny.

LaVonna:

The stories that I continue to read regarding Cigna absolutely disgust me. My mother has been deemed totally disabled by Social Security’s standards for the last several years and had this carrier through her employer. Cigna made a few payments and then took it upon themselves to decide that she is not disabled and can perform some form of work. Her health issues are endless and get worse each day. I know that at this point the only way this issue is going to be resolved is through litigation and am preparing for the fight, but it is awful that things have to get to this point. There was no gripe when they were taking payments for services which they have failed to and continue to render. I pray no one else has to endure their madness, but for some reason, I don’t see it ending soon.

Attorney Greg Dell:

LaVonna,

Please make sure your Mom submits a timely appeal of any claim denial. If she already has appealed then a lawsuit must also be filed timely. Let us know if your Mom needs assistance.

Jul:

I worked for CIGNA for 16 years then my entire family, including my dog, got sick. Went to 8 different doctors for my medical condition. The short term unit only spoke to 1 doctor and denied my short term. I kept calling HR and left 10 messages telling them that I wanted to file a discrimination complaint on my manager due to my disability and the HR department never called me back. I guess the 11th time is the charm – I get in touch with the HR rep who informs me that I should openly discuss my medical condition with my manager so she can understand what I am going through. I gave instances where she had discriminated against me before and violated Hippa. I asked him if he actually took the compliance yearly test because per the federal mandate I do not have to discuss my medical condition with my manager. I told the HR rep I would be appealing the short term disability’s decision and asked if my job was in jeopardy. He stated No, you are currently out on leave. I hang up the phone, answer the door and there is a Fedex man there with a box from CIGNA. My boss had mailed me my desk and in the mail was a letter from her stating I was no longer an employee due to no response from an earlier letter, first I never received any earlier letter, and where is the HR department in all of this? So I lost my job, my dog ended up dying, I have lost my storage unit, still trying to get better but lost my insurance and getting ready to lose my house, all because CIGNA allows managers to harass, abuse and torment their employees and they don’t protect their employees against the same federal laws that apply to all other companies. The feelings I feel are so raw and explosive. I lost everything and am still sick and this company didn’t give a rat’s ass that I gave my heart and soul to them for all these years and one boss has it out for you and that’s it. Shame on you CIGNA!

Nicole D. Paul:

Hello all who Cigna continues to deny.

I, too, am in the same position. The story is the same, isn’t it.

You have a job.

You become unable to perform your work.

You are happy you have disability insurance through your company.

In my case, I was approved for Short Term Disability (through Cigna) for 81 days. Then, during the ‘transition to Long Term Disability’, I was denied. Then, I lost my job, because I was unable to return to work due to my documented illnesses.

Now, you have no insurance, to continue seeing doctors, and you’re have no money because Cigna isn’t paying you. And, you certainly can’t afford Cobra.

Long Term Disability then denies the claim and says, there’s not enough supporting documentation, although you’ve had all your doctor’s fill out their crazy forms.

Of course in the midst of this, they lose your documents, they claim they didn’t receive your documents (despite your fax confirmations), and you run around trying to get copies from the medical providers to re-send to Cigna, which you really don’t have the mental or physical capacity to do.

Then your case manager (which changes like the weather) tells you to appeal. So, you continue to gather additional documents, from the doctors who have already sent the documentation that clearly states you are unable to work.

Now, you’re fighting bill collectors, and trying to keep your sanity, while worrying about how to pay the rent, lights, water, and put gas in your car.

So, you appeal, which is denied at almost lightening speed.

My first appeal was 94 pages long. It had a whole table of contents. It included medical records, hospital records, their forms which had been completed by the doctors, emergency room records, personal statements, and an entire appendix section. My appeal was denied in 3 days, due to lack of documentation.

I’m now on my second appeal.

I checked in with my latest case manager (appeals) to ensure she’d received the latest 10 page fax, and she claimed that she didn’t receive it. She said, it was a big office and it was probably picked up by someone else. She asked for me to send it again. SERIOUSLY! I asked HER to confirm (via the FAX machine’s transmission/transaction log) that at least the FAX MACHINE got it, even if she didn’t. She ignored that request.

I then asked her for her e-mail address, which she reluctantly gave to me. I then e-mailed her the 10 page .pdf, and called her back to ensure she had received that!

Get e-mail addresses from case managers if you can!

Unfortunately, my illness is that of anxiety, depression, and panic. Dealing with Cigna has sent me to the Emergency Room twice, and cause my depression to become so deep that suicide seems like a better option than dealing with Cigna. However, I will not give them the satisfaction, and my family needs me, and I’m going to fight them tooth and nail. Nearly daily, I feel incredible rage at the injustice of this. I have been destructive, I have killed a cell phone after talking to one of my case managers. I have literally sat in my driveway rocking and sobbing at reading yet another denial letter.

Thus far, I have not retained legal counsel because I’m afraid that the I am going to have to pay the attorney’s the bulk of any settlement which puts me back into a bad situation.

My family and friends, continue to pray fervently for God’s intervention. Because, we know that He cares for each and everyone of us. If nothing else, this journey with Cigna has increased my faith and proven that I can do nothing without God. He is the one that provides a peace that surpasses all understanding.

So, yes, Cigna and their case workers, nurses, and all those others that strive to deny us the benefits that we have paid for will ultimately pay for their part in this madness. Until then, I encourage each of us, to NOT give up. Document everything, keep copies of everything, log your phone calls, e-mails, faxes… everything.

I recently requested a copy of the Cigna (and LINA) policies for my own records. And also found this case online which is eerily similar to my case.

In my last and final e-mail to Cigna, I have told them that if my latest appeal is denied, I’ll file suit within 14 days of their decision.

I’m tired of being on the defense, I’m going on the offense now.

Keep hoping and Keep living… but don’t let them win by giving up. That’s what they want and that’s what they hope for.

God Bless You All!

Attorney Greg Dell:

Nicole,

Thank you for sharing your experience with Cigna. The important thing is that you don’t give up and you keep fighting them. Since you have already submitted all of your appeals you are past the point where any attorney could help you during the appeal stage. If your appeal is denied, then please contact us and we will review your claim to determine if we can file a lawsuit against Cigna for you. Good Luck and take care of yourself.

Nicole:

I’m glad it didn’t come as a shock when my latest appeal was denied last week. I was hopeful, but not surprised. I’m tired. Cigna does a great job wearing you down – I wonder if they had a hand in carving out the Grand Canyon. I’m waiting until I receive the actual letter, which will be added to the basket that contains all the correspondence. After that, I’ll give the office a call. I think right now, I’m scared to be told that I don’t have a claim against them – another big fat no is not what I’m ready to hear right now. In the meantime, I really have to look for work. The medical bills are coming in fast and furious. I’m so tired and struggling not to let my mental health suffer any longer. It’s hard. Depression is enough without Cigna pounding away with their endless minutiae.

DH:

CIGNA (LINA) would have and still would like to see me dead or homeless. I have been fighting for 2 1/2 years. I am only 45 years old and severely disabled by Fibromyalgia. They actually hired a firm to get me my Social Security Benefits to offset their payout amount; then suddenly denied that I was disabled; always denying appeals because they didn’t have enough information. I asked them to even come and spend a week with me. Now I’m still in the fight of my life. And in my case I’m told that the policy is ERISA exempt which I am still trying to find out what that means. God Bless Us All.

Attorney Greg Dell:

DH,

Having an ERISA exempt policy is a great thing for a disability claimant. To learn about why ERISA is an unfair law for disability claimants, we recommend you watch this video. Since your policy is ERISA exempt, this means that you will be able to have your case brought before a jury instead of a judge. In many cases this could be an advantage because you get to come to court and tell the jury your story. In an ERISA case, the judge reviews nothing but papers and never gets meet or hear from you personally. In some states, an insurance company could be subject to bad faith or punitive damages if a policy is ERISA exempt. Every case is fact specific and the laws are different in most states when it comes to ERISA exempt claims. Keep battling Cigna and with the right representation justice will prevail.

Jeff Benton:

I am also being denied long term disability from Cigna. I have sent in every paperwork they wanted, my Dr. also has called them and I am waiting for the appeal letter they said they are going to send… In the meantime I am about to lose my house, car and everything else I had worked hard for… and I can not return to work until I go back to see the Dr. in Oct. What am I supposed to do?

Attorney Greg Dell:

Jeff,

This is Cigna’s process of trying to strong arm a claimant back to work. You need to try your best to not give into Cigna and make them pay you. With proper doctor support you should be able to prevail in your claim for disability benefits. Make sure you submit all of your medical documentation to Cigna. Contact us and we will let you know immediately if we can help you.

Jos S.:

Wow – didn’t know everyone else was having the same issue. Have worked all my life in Human Resources and now this same thing has been happening to me. I’m at my wit’s end. Was being tested for Multiple Sclerosis because I cannot walk etc…. won’t go in to the rest – but meanwhile – they cut me off (terminated my job and cut my insurance off). Now – not only can I not see the doctor because I can’t afford it – no meds, no nothing. At my age – it’s difficult to get a job. Now they gave me confirmation numbers of the ‘claims they paid wrong’ along with giving the confirmation numbers to the hospitals. I called tonight and they said they’re not paying anything else. So… here I sit – can’t move, in horrible pain, etc…. I’m ready to file a suit before it’s too late. Don’t know anyone close to my area.

Attorney Greg Dell:

Jos,

If your claim is a disability insurance denial, then you should contact us ASAP to discuss your options. We represent clients nationwide and if we can help you then we will. If you have received a denial letter, then please contact us privately and we will immediately let you know if we can assist you. You need to find a way to get medical treatment, even if that means taking yourself to the Emergency Room. The hospital will not turn you away. You have to receive medical treatment in order to collect disability insurance benefits.

Jeff Deal:

I too have been denied both my short term and long term benefits from CIGNA. Faithfully paid all premiums for the coverage all the time I was employed… approximately 35 years… same paper trail, and smoke and mirror games for the last 25 months. My question is why isn’t or hasn’t there been a class action suit of something done on a national level? It is outright fraudulent what they are getting away with and something needs to be done to protect us from these type of criminally negligent practices, especially when we are hurt, incapacitated, or disabled.

Brittney R.:

I’m still in the same boat as everyone else here. I recently came across some new information (new to me) that allows me to get a copy of my Claim File from Cigna.

I was told to send them a notice (signed) that says, “Since you have made an adverse decision on my claim, I would like you to send me a copy of my entire claim file, including the claim notes. Since my claim is governed by ERISA, I realize that I am entitled to a copy of the claim file.”

I faxed a letter to them with this exact verbiage, and I was told that they will send me the file.

How will having THEIR file help me file my next appeal? Or, will it?

Or, are my appeals a waste of time, coming from me? I have to make a decision to pursue this legally, or to file my next appeal.

Do they response better to lawyers? Is it even possible to WIN an appeal by an individual such as myself?

As a long time, professional writer, I keep thinking that perhaps I can refute their denials if I just write well enough, and present the evidence (from the latest doctors). Am I hopelessly in denial?

Attorney Greg Dell:

Jeff,

Great question. Nationwide class action lawsuits are very restrictive and have strict criteria that must be complied with. In disability insurance claims it is difficult to bring a class action lawsuit that makes sense, as the recovery in a class action may not properly compensate each class member. The department of insurance in each state needs to regulate and punish the wrongful actions of a disability insurance company. California has fined Cigna in the past for their actions. We have pursued a class action against Prudential in the past, but the basis of the action was due to their claim handling procedures which affected all policy holders equally. In your case, you would probably be better off filing your own lawsuit, rather than getting involved with a class action. Contact us if you would like to discuss your claim.

Attorney Greg Dell:

Brittney,

You have asked several questions which require a long explanation. We have produced several free videos which I think will answer most of your questions. You can watch two of these videos about the ERISA appeal process at http://www.diattorney.com/group-erisa-claim-denial/. Contact us privately and we will provide you with a free review of your denial letter and discuss how we may be able to assist you. Please keep in mind that you only have 180 days to submit an Appeal or your claim for any additional benefits could be barred. We have won numerous Cigna Appeals for our clients and while we don’t recommend it, it is possible for you to win an Appeal on your own. The difficulty with handling a claim on your own is that you could be at a significant disadvantage if you lose your Appeal and then need to file a lawsuit.

Kelly:

My situation is very similar to everyone above. I at first was denied LTD benefits, I appealed it and was awarded LTD benefits until the age of 65. What a joke… They faithfully paid for 18 months; however, on month 9 of my journey into this web, I was sent letters stating that they were going to be doing a review of my disability after the first year

That makes sense to me… except, the complaints came to me that my doctors were not sending records and could I please get this records. I did my best, under my condition, it took several months, but I got records for the entire year of 2011. In March I receive a call from this very rude “case worker” whom I never heard of. I told her, who I had been dealing with and that the records were faxed, as I faxed them myself. She told me that she took it upon herself to take over my claim and that she need current information from Jan 2012 to that time, which was I believe April 2012.

My mistake, I went on to explain to her, that I will try, however, it is difficult for me to obtain info since I can no longer drive due to my disability, and I had been in terrible pain. (they found a fracture on C2, with addition disintegration within my spine) I told her that I was going to see another neurosurgeon, as I was going to require addition fusion. C1 all they way down to T3. My next mistake was to ask her for her credentials regarding making life changing decisions on my behalf. She stated, “I have been trained to do my job”, I ask, “are you a nurse?” “No” I say, well that explains why your lack of understanding of what is going on with me. etc… I then explained to her, I was a critical care nurse of 22 years. Her next comment blew me away… she said well, I can always just sit down and make a determination on your file with what is in here, lacking current information.

I knew right then I sealed my fate with CIGNA. Even after, I faxed her current pertinent info. I still received a denial, as I can perform “any occupation”. Anyone that has had cervical fusion understands the intense muscle spasms that occur since one’s neck no longer has the complete ability to rotate your head. To help minimize the spasms, I receive Botox injections in my neck every three months. It helps a lot, but it is temporary, and the side effect is that I have a hard time holding up my head during the first several weeks, until it wears off.

That was their reason for denying me my benefits. I showed improvement after receiving Botox. On May 2012, they stated I was no longer disabled… however, they were sending me a lump sum of my remainder of payment through the year 2012? On August 3rd, I was awarded my SSDI, with a fully favorable decision.

I have overwhelming evidence in radiology exams, neurosurgical reports of my fracture, and that it is millimeters away from cutting into the vertebral artery. I will be having surgery this month, I will be in a halo for 4 months. I have my SSDI award letter, so I am attempting to write my own appeal letter. If further denial comes, then I will seek counsel with a ERISA attorney and file the first law suit I have ever had to do. One thing I still have is the tenacity to NEVER give up!!

What irks me is that, that Tanya with CIGNA, deliberately withheld known information from the Nurse claims manager. As I talked with her. If you have any advice on how to write the letter I would appreciate it. I have done searches to find sample letters… so I do have a couple of them. I am wanting to know, is it wise to bring attention to these people that there claims people are not performing there job correctly? Or are they? I have heard to write to humanize my situation… and just keep my “typing” to myself regarding that woman Tanya.

Now that I have been awarded my SSDI, after my 2 years of fighting for it, I am starting to receive back pay paid to me. The group that represented me, has gotten there pay, but CIGNA, is going to want there money back. I fully agree with this, however, now I have leverage. They want me to sign a form that gives them ability to deduct from my checking account what they feel is owed back to them.

Here is my last question: Is it wise to sign that? I don’t think so! Also, since I am sending in my appeal, with the evidence proving that there decision was grossly wrong, I want my benefits fully reinstated, and then to negotiate with them a payoff. As it will stand they will owe me approx. $450.00 a month until I am 65. I never want to go through this again. Pay me off with a lump sum, minus past due amount, and then come to an agreeable payoff amount. Do I have a leg to stand on?

Attorney Greg Dell:

Kelly,

Your CIGNA disability denial sounds like a typical denial. You need to be very detailed in a strategic manner by filing your own appeal. Please watch our videos on ERISA Appeals. If you policy does not require you to sign an SSDI reimbursement form, then you may not want to sign it. You still will likely need to repay SSDI benefits for any period that matches when CIGNA paid you. A lump sum buyout could be a viable option if you win your appeal. We wish you luck with you appeal.

Kelly:

Greg,

Thank you for your response! Also for the link to the videos on ERISA appeals. I am going to start watching them tonight. Yes, my policy does state that if I receive SSDI back payment, then CIGNA does want the portion that I will receive from SS. Actually, it becomes even more complicated, as I am the spouse of a retired railroad employee, with over 30 years service, so I will receive my monthly payments from them. And I fully intend to pay CIGNA back, I feel that would be dishonest if I didn’t, not only that, but I would find myself in court! But I am not comfortable giving CIGNA blank access to my account. I’ll send them their money via cashiers or money order.

I have until 10/16 to formulate my appeal, and get it sent in. My surgery date to fuse me from C1 on down… with a halo in place for 4 months. I have to have all this behind me in order to focus on recovery!

I contacted another company, but they didn’t realize that there would be an additional pay off. I guess they felt there was no incentive for them.

But after I appeal, and I win it, I will then continue to receive approx. $470.00/month per my policy or approx. $6,000 a year for the next 16 years. You know they will want to attempt to offer a buy off. or buy out? Whatever the terminology is. At least that is my uneducated legal guess.

I hope I am able to express myself correctly, my motives are to get the denial reversed with CIGNA, begin receiving my monthly SSDI payment via railroad retirement board, most definitely pay CIGNA back the portion that I receive in back pay, then either continue to receive monthly checks from CIGNA, or negotiate a lump sum.

As that was the whole purpose of having that policy, I’m grateful I have it. So, when I say that I want to use that “back pay” as leverage, I don’t mean I don’t have any intention of paying then back. CIGNA knew I was going for additional surgery, but they also knew it was a future activity. I think they just wanted to get my denial at the 24 month point done 8 months early (it also cut out that cost of living raise at 18 months!). Yet, they paid me a lump sum for the period of 5/2012 to 12/2012. With no letter of explanation or anything, I received the denials two weeks later)

Is this typical of CIGNA to practice like this? I know they made some very unreasonable demands regarding documentation, and then picking a sentence out here and there without looking at the whole picture. I would have denied a claimant using those methods also. But it is wrong… I can see where many people would just throw there hands in the air and give up.

My question for you at this point is, would it be wise to get a free consult with your company? Or can I hire you or someone in your company to look over my appeal and make suggestions prior to sending it off? But I don’t want to wait until the beginning of the Appeals time frame. Like I said, I have overwhelming proof that they were wrong to make that decision the way they did. I want to “humanize” to the reader of my appeal, yet, should I practice “pen/type in cheek” regarding there actions taken to come to a denial decision.

My case is considered “closed”, yet I still have a claim manager until the end of the year. I don’t mean to be repetitive here, but I just got my surgery date today, giving me two weeks to put this together prior to surgery and already have my outline and a rough draft. I also have copies of what I consider the “smoking gun” The progressive nature of degenerative disc/bone disease, now I have a fracture on C2 as a result. New evidence of degeneration in the lumbar area, showing evening more progression. They didn’t have the information on the fracture at that time, but they did know I was complaining of worsening pain, change in type, intensity of my pain, and they knew I was scheduled to see a neurosurgeon as I had failed all conservative attempts at pain control .

Sorry, I could go on and on…

Kelly

Attorney Greg Dell:

Kelly,

Thank you for your detailed comments. It would be very wise for you to contact us for a free consultation. Please call at the time that is convenient for you and any of our disability attorneys can assist you. It would be helpful if you completed our free consultation request form and then emailed or faxed us a copy of your denial letter.

BJ:

I am a now 60 year old seizure patient for 33 years with various illnesses resulting from the anticonvulsion medication such as panic attacks, depression and anxiety. All are side effects of the prescribed meds. Since my initial diagnosis for ltd was seizure disorder after having brain surgery, the side effects are not considered part of the disorder even though I have to take these meds for the rest of my life to control my seizures. Because they are being somewhat controlled Cigna has denied my appeal after attending a fce meeting where it was stated that I had self limitations on most of the tasks. The PT that administered the tests stopped over half of the test due to the amount of medication I am prescribed. Also stated in my denial letter was I am able to return to sedentary work as a medical claims examiner which was my profession prior to my surgery and disability.

shawn m:

Laura – I am so sorry to hear about your continuing problems but your story also helps me realize that how fortunate I am. In August 6+7 I had a 2 day surgery. Day was an identical 3 level ACDF and day 2 was a 5 level c3 through c7 posterior laminectomy with instrumentation While my recovery has been slow, I am making progress and the pain/discomfort is manageable. Nov 8, I met with my surgeon, and we agreed on a Nov 26 return to work. The doctor said that considering the scope of the operation my progress was excellent including my strength. Cigna got into a tif with my surgeons office so they just considered the excellent progress comment as indicative of me being fully capable of working and subsequently denied disability coverage after Nov 8, so from the 8th to the 26th I was out of luck. Then on Dec 5 they discontinued PT benefits even though my PT said I am about 60% of normal. I take this very personal as I was the type to go years not taking sick days Their implication that I was cheating them was dispicable I found a medical disability advisor reference that said for my age and surgery, expected out of work time is 140 days. I returned a little over 90 There are days when I am extremely uncomfortable but after reading your horrors, I will keep reminding myself how fortunate I really am. I am not done with Cigna yet

Attorney Greg Dell:

Shawn,

It is pathetic that you try to make an amazing effort to return to work early and Cigna punishes and penalizes you for doing it. Cigna and the person that has been giving you a hard time should be fired for their actions. Congrats on your amazing recovery and your positive outlook. If you need assistance in the future, please let us know.

Allison:

My husband worked for 36 years as a salaried supervisor, alternating shifts, in a paper mill. Eighteen months ago, he had a massive heart attack, and has been unable to return to work. During his short term disability phase, the company announced layoffs, and he was a convenient subject. He was assured by the company that the layoffs would not affect him since he was on STD, soon to be LTD. He paid for LTD the whole time he was on salary, little did we know the problems we would have.

Cigna has denied his claim 3 times, despite letters from his physician that state he is unable to return to work. They have ‘cherry-picked’ examples which “prove” their claim that he is able to work. They chose days in cardiac rehab when his self report was no chest pain, and ignored the charting done that states he had been so short of breath they had to stop. This last time, they tell him that since he has a “sedentary” job, he can return to work. This despite a letter from his employer stating that he does not have a sedentary job and was subject to constant stairs and temperature extremes (which he does not tolerate). He was approved for SSI immediately, but Cigna continues to make us wait. The so called appeals expert is Rui Cunha, who will not return our repeated phone calls. We don’t mind paying an attorney, especially if we have to sue, but taking a portion of every month that we get disability seems a little expensive.

This is just another example of Cigna thinking we are going to just “go away”. We are living off of savings, and are so glad we have them. I am employed so that helps. It is just sad that this is the thanks he gets for being so hard working for so long.

Attorney Greg Dell:

Allison,

Three denials by Cigna is a lot. Make sure you do everything possible to build and submit the best appeal possible. Contact us if you end up having to file a lawsuit and we will let you know immediately if we can help you. The attorney fees are inexpensive compared to the amount of total benefits your husband will be seeking. Unfortunately, insurance companies try to strong arm claimants which are not prepared to battle against a large insurance company. We do this kind of work every day and are here to help people like your husband.

Allison:

I made a mistake… it has only been two denials. We are on our second appeal and haven’t heard anything. Rui Cunha won’t return calls…

I will be in touch. Thanks for answering!

Peter:

The most unethical immoral and illegal “racketeers”. Fight them to the end. Sincerely victim #?

Beth:

Of course, same here, but my husband’s disability is not physical, but mental. Maybe early Alzheimer’s?

Since Cigna is mostly geared toward physical and there is no test for Alzheimer’s, the burden of proof is extremely difficult. How do you fight something like this? I have POA for my husband, if I file suit, can I seek damages for myself? I am also disabled and, as you know, the PTB are destroying everything in our lives. I’m out for blood!

Attorney Greg Dell:

Beth,

ERISA does not allow you to sue for damages for yourself. Alzheimer’s and dementia type conditions are usually not limited to 24 months and can be argued as physical conditions.

IMA in FL:

After reading comments posted by others, I realize that Cigna is running a major scam by collecting premiums and then doing everything in their power not to pay claims. What a great scam they have going! When a person is sick and disabled, they are less prone to put up a good fight or spend hours and hours chasing paperwork in circles to satisfy Cigna’s absurd requests for documentation.

My mother has Alzheimer’s Disease and Cigna says she should return to work. Meanwhile, she can’t drive and doesn’t remember half the people she once knew. They have stopped her payments. Same story as all the other countless victims I am now aware of.

My question is, when is this going to get some news coverage?! Let’s get some airtime for this!

Attorney Stephen Jessup:

Ima,

Thank you for sharing your mother’s story. Hopefully with enough outcry there will be increased news coverage and stories exposing what the insurance companies are doing to their insured.

Debra Hange:

Ima,

I hope for the same thing… I fought for almost 3 years and am now sicker than ever. I knew they were making me sicker as I fought. Now I may have not only lost the war with CIGNA, but lost my fight with my health. I feel like I am fading away.

A:

I, like everyone else here, has had my LTD payments from Cigna denied. They paid for 14 months and then decided I was able to go back to work after my fourth back surgery which was a multi level 360 degree fusion. I have permanant nerve damage and live in constant pain since June 2010. I am lucky enough to be covered under my husbands medical and was found fully disabled by Social Security but am facing a multi level cervical surgery. I did hire an attorney and have filed suit against Cigna in District Court. Will be attending an Early Neutral Evaluation Hearing soon. My husband believes I should be entitled to the full amount Cigna would have to pay until full Social Security Retirement at age 67, and if they don’t want to settle for that, to take the case to trial, but my attorney says to not do something to harm myself. How is taking them to court going to harm me anymore than what they have done? Cigna needs to be held accountable for what they are doing to people, especially the ones who can’t fight them. I am going to start writing to my congressional representative and to the ones with oversight to insurance. Why isn’t there more news coverage on this horrendous problem? Why is this kept secret from everyone? If people only knew that their ERISA covered policies were nothing, they wouldn’t take the coverage and Cigna wouldn’t get paid. Maybe that is why this is all kept quiet.

Attorney Stephen Jessup:

A,

Unfortunately you are not alone in your experience. The problem with ERISA policies is the fact that since the premiums are so low they provide coverage that as you have experienced is not very good at times. Couple this with the difficulties of ERISA based litigation and you have a recipe for insurance companies to act egregious. On the flip side, you can purchase private disability coverage through an agent that offers much better protection, but with that comes very high premium rates that many people cannot afford. We wish you the very best in your pending action.

Kelly:

I just wanted to respond to everyone that the advice Greg gives is vital to winning any appeals with CIGNA! I have written in with my complaints with CIGNA in the past. I found that I make sure I have copies of every doctor’s appt. I go to, every X-ray, CT scan etc… radiology report. If I feel that it is time for another X-ray of some sort, due to increasing pain or other symptoms, I don’t wait for the doctor to recommend this. I suggest it, so I make sure I have a new X-ray every 6 months. Don’t ever miss a doctors appt., and always follow through with their suggestions.

Make copies of all paperwork from all the different medical appts., keep notes of everyone you have talked to. When I filed my last appeal, I sent in a 35 page letter starting from the beginning of the year that I was denied, and went methodically through the months. Having every page that I copied numbered and then referenced that page in my letter. I also made several complaints with names to Cigna about the claim managers background, titles anything I could get a hold of. Especially any supporting information to prove that the information Cigna used to deny me was inaccurate. And I was willing to appeal until I either got approved or the highest court told me I was done.

I was approved after my last appeal, however, I continue to do what I have been doing as I have read of Cigna denying patients again, and again. It seems that their whole thinking is that I will get tired of dealing with them and give up. Just don’t ever give up, and stay on top of your medical issue.

Attorney Stephen Jessup:

Kelly,

Thank you for sharing your experience and your kind words. Cigna, like all disability carriers, rarely back down and will continue to require continual information. It really is a war of attrition.

Linda:

Do the doctors that Cigna chooses for an outside evaluation get paid more if they say someone is able to work? Also If someone is awarded LTD is it in their best interest to try and negotiate a lump sum payment so they don’t have to deal with Cigna EVER again?

Attorney Stephen Jessup:

Linda,

There is really no way of knowing as the only documentation noted in claim files with respect to payments to outside doctors is simply a bill for the amount owed. Cigna does engage in lump sum settlement negotiations on a limited basis and have a internal criteria as to same. If you have questions regarding potentially securing a lump sum settlement of your claim please feel free to contact our office to discuss.

Atif:

Hi everyone,

I was receiving benefits from CIGNA as well, until about November 29,2012, when CIGNA just stopped my benefits and sent my file to Praxis, they were hired by CIGNA for coordination of benefits, overpayment, subrogation and reimbursement from CIGNA in dollar amount of $37,946.64. Now on Sept. 18, 2013, I got another letter from CIGNA about overpayment in amount of almost $5,000.00.

If anyone has any suggestion please let me know, I will be getting in touch with my attorney.

Thanks.

Theodore:

I also had trouble collecting my long term disability claim payment. I fought with them for well over 1 year, Cigna uses the system to their benefit, and also takes advantage of the laws. The main thing that worked in my favor was my knowledge of HIPPA, and how Cigna uses this law to their benefit. Due to HIPPA, any medical professional would NEVER discuss his patient with any one over the phone, and this is exactly what Cigna is depending on. In order to overcome this, when my second level appeal was submitted, I advised them that any information they need to submit it in writing to my specialist along with the medical release, and they would answer all questions. This did create a slight delay in the claim being processed, but at least it was processed correctly where I received the benefits I was due. The other thing that any one who is having their claim denied, they need to go to an Occupational Therapist. This you may need to do at your own expense (Cigna knows that this is usually not considered medically necessary), but at least this would give you a fighting chance against them. When Cigna processes your claim, they create a “character” of you and based on everything going perfectly how long your recovery should last. This they do with occupational therapist in oprder to document their decision on payments.

Attorney Stephen Jessup:

Theodore,

Thank you for sharing these valuable tips.

Lu:

I am in the same boat. My SSDI was approved and I did get STD from Unum but Cigna said I didn’t have enough medical documentation as well as a law firm who was looking at my case. It seems it should be rather cut & dried when the doctor has me with restricted activity and my employer says I cannot work with restrictions then I should meet their criteria. I’m overwhelmed still by paperwork just trying to maintain food stamps. The attorney wanted to know why I wasn’t seeing my doctor more often. I told him because there is nothing more he can do for me. When I first started with my condition I had a different PCP. We had a bit of a falling out and I changed PCP. But it seems Cigna is going off documentation by this doctor who hasn’t seen me since May.

I’m an RN and was working as a staff nurse. I hurt my back on my own time-a muscle strain – but even though that has resolved I continue to have pain. I’ve got bill collectors hounding me, I’m going to have to move as I cannot afford this place now. Along with the back issue I have IBS and depression/anxiety. It’s really hard to keep seeing the doctors when you have no money.

Attorney Stephen Jessup:

Lu,

Thank you for sharing your story. I am hoping your attorney will be able to secure your benefit for you.

BJ:

I’ve been fighting CIGNA Insurance since I lost my job of 10 years due to increased symptoms and increased need for medications. This from an “orphan” Mast cell disease. I did safety critical work, and now am so forgetful I could hide my own Easter eggs. I suffer severe “brain fog,” joint/muscle pain, blurry vision, extreme weakness, and headache, frequent vomiting, diarrhea, … I could go on. I was approved by SSI, tho my case was flagged as being approved too quickly. Reviewing SSI folks sent me to a local psychiatrist, who happened to have a strong interest in Mast cell diseases. He recognized my multi-year decline as, in his words: “textbook for your disorder.” SSI approved me the following week. I’m now a few days shy of my 1st anniversary of dealing with CIGNA, and just received my 4th rejection from them. They have the same information as SSI, including the SSI doc’s letter and exam notes, but it’s not enough. Every contact I had with them, I was asked for more information. (Just my family doc has me in 4 separate folders, each over 6″ thick. I’ve seen her for over 20 years, and EVERY 3 MONTHS for the last 10 years. They have copies of every page in those files, plus my files from 4 specialists, including 2 internationally recognized clinical and research experts.) They say there’s disagreement between my doctors (very little, minor issues, and only because my family doc doesn’t have a strong background in my disorder). They whined because one doc doesn’t yet embrace electronic records, is something of a Luddite, and her penmanship is terrible. They say SSI didn’t supply adequate information on how they determined my disability. The SSI doctor’s exam notes stating “organic brain syndrome,” extreme brain fog, pain, etc didn’t impress them. It’s been a tough year, and my disorder is made much worse by stress. I’m both depressed and furious.

Attorney Stephen Jessup:

BJ,

Your 4th denial of benefits? At this point you may only have the option to file a lawsuit against Cigna. Please feel free to contact our office to discuss how we may be able to assist you.

Mary K.:

I have been drawing LTD from Cigna since 2008. I had 4 surgeries in 2008, cervical fusion, right shoulder surgery and both hands operated on, all within months of each other. I was sent to a independent doctor who evaluated me and submitted his findings – permanent disability of 26 percent of the whole body with restrictions on movement and lifting, etc. Now CIGNA is all but said they are going to deny my claim (at least that is what I am told unofficially). I continue to see my doctor for pain management of these conditions. Find it hard to believe that after 6 years of being on disability I am suppose to be all of the sudden better. I was earning around $26 hour before disability and of course drawing 60 percent of that on disability there is no way with my permanent restrictions I can come close to earning anywhere close to my 60 percent. Any advise or suggestions with this? Is it better to start of with a lawyer? If I am denied and do have to return to some type of employment at a very low rate of pay is CIGNA required to make up the difference to the 60 percent? Please advise.

Attorney Stephen Jessup:

Mary,

I would strongly suggest you consult with an attorney as it relates to filing an appeal. Cigna typically only provides one level of appeal, and if the claim is denied your only option is to file a lawsuit. If Cigna denies your claim, they will not, nor are they required to pay any difference in earnings or pay any benefit. Please feel free to contact our office to discuss how we may be able to assist you.

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