Cigna Overturns Denial Following Dell & Schaefer Appeal
Author: Attorney Victor Peña
Ms. D contacted our firm when she was denied long term disability benefits by her disability insurance carrier, CIGNA. Ms. D was a Catheterization Lab Tech and was often required to perform her duties during stressful situations involving emergencies like heart attacks and other life-threatening events. She was required to be on call for a minimum of 24 hours, often 2-3 times per week. She had a demanding job that required her to have the ability to maintain focus and concentration.
Unfortunately, Ms. D began suffering with depression and frequent and unpredictable anxiety/panic attacks. The events were often physically and emotionally paralyzing making it impossible for her to function for hours at a time. She was also suffering from migraines 1-2 times a week.
Due to her symptoms she was left with no choice but to apply for disability benefits as it became too difficult for her to function in a safe manner. Cigna initially approved her claim for short term disability benefits but terminated the claim shortly before it transitioned to long term disability following an internal file review.
Given her condition, Ms. D felt overwhelmed dealing with Cigna on her own so she contacted Dell & Schaefer and spoke with Attorney Victor Peña who agreed to take on her case.
In denying Ms. D’s claim, Cigna had relied on a review by its behavioral health specialist who spoke with Ms. D’s therapist and confirmed that Ms. D suffers from debilitating symptoms. Despite the support from Ms. D’s treating therapist, Cigna denied the claim. The denial letter indicated that Cigna had been unable to confirm a functional impairment beyond July 6, 2016 that satisfied the definition of disability as stated in the disability contract. Like many of Cigna’s denial letters, the letter used standard “cookie-cutter” language often seen in Cigna’s letters.
In preparing the appeal, Attorney Peña and his team worked on gathering additional evidence of Ms. D’s Condition and requested the completion of custom questionnaires by Ms. D’s treating providers. The questionnaire addressed every problem that Cigna claimed existed with Ms. D’s claim. The appeal focused on the clinical findings evident in Ms. D’s medical records that Cigna had overlooked or failed to investigate.
After reviewing the appeal, Cigna had no other option but to overturn its denial of benefits. The appeal addressed every reason relied upon by Cigna in denying Ms. D’s claim and made it clear that Ms. D’s condition satisfies the definition of disability as stated in her short term as well as her long term disability policies.
Cigna issued all back benefits owed and continues to pay benefits.
The Attorneys at Dell & Schaefer have seen many claims denied by Cigna and their cookie cutter language is used routinely by Cigna when denying claims. Our attorneys have developed appeal strategies specific to the insurance company and have been very successful in getting denials overturned.