12 years of disability payments paid, but CIGNA suddenly determines claimant can perform sedentary job

A disability claimant receiving benefits from CIGNA can never let their guard down. CIGNA is constantly evaluating their claims and if they have an opportunity to deny disability benefits then they will do so. This case is an example of a woman that was paid over 12 years, before CIGNA decided to unreasonable pull the plug. Despite a deterioration of this woman’s medical condition, how could CIGNA really expect this woman to return to a 40 hour job?

The plaintiff, by virtue of her employment with Markel, was covered under an employee Long Term Disability Insurance plan issued by CIGNA Insurance Company. During the time that she was employed, the plaintiff was diagnosed with Lyme disease and fibromyalgia which causes her chronic pain, muscle spasms, difficulty sleeping, decreased energy, decreased memory and difficulty walking, standing and sitting.

Due to the severity of her medical conditions, the plaintiff stopped working on July 1998. She was approved by CIGNA to receive long term disability benefits on June 30th 1998 effective from December 30th 1998. In 2004, the plaintiff was also diagnosed with bi-polar disorder, depression and anxiety. She was also further diagnosed with degenerative disc disease, including a herniated disc. In 2005, the plaintiff suffered from severe gastroesophageal reflux disease (GERD). She also underwent a fundiplication to remove a hiatal hernia in 2006.

CIGNA Denies Disability Benefits

On February 1st 2010, the plaintiff was informed by CIGNA that it was reviewing her claim for continuing disability benefits eligibility on the ground that the plaintiff’s claim file did not currently contain information to support continuing long term disability benefits payments. CIGNA specifically cited a Physical Abilities Assessment (PAA) from one of Plaintiff’s physicians, dated November 2nd 2009 which they interpreted as a finding of “sedentary work capacity” and requested any other information that would refute the information provided by the PAA.

To support her claim for continuing long term disability benefits, the plaintiff underwent a Clinical Neuropsychological Evaluation and Functional Capacity Evaluation which concluded that it was doubtful that the plaintiff was able to work with any gainful employment of any type.

CIGNA Denial Letter Sent To Claimant After 12 Years Of Payment

Nevertheless, the plaintiff was informed by CIGNA on July 13th 2010 that she was no longer eligible for long term disability benefits. CIGNA interpreted the phrase “sedentary physical demand level for activity” as having some capacity for working ability the conclusions of the Clinical Neuropsychological Evaluation and Functional Capacity Evaluation. CIGNA also claimed that the plaintiff’s main disability was her psychological health which CIGNA considered as “Mental illness”. This meant that the coverage for long term disability benefits was limited to 24 months only and disregarded ClGNA’s original approval for long term disability benefits in 1999, which is five (5) years prior to the diagnosis of any psychological issues.

CIGNA also claimed that the plaintiff was not undergoing regular treatment for her psychological issues. In her appeal to CIGNA’s decision to deny her claim for long term disability benefits, the plaintiff submitted supporting documents and a letter from her attending physician which specially challenged CIGNA interpretation of the PAA and stated that:

It is difficult to comprehend how you reached the conclusion that Ms. Goble is no longer disabled.

Despite arguments to support her appeal, CIGNA denied that plaintiff’s appeal on November 20th 2010.

Relief Sought In The Lawsuit

In the lawsuit, the plaintiff argued that CIGNA had taken sentences from several reports out of context in order to support its ground for denying the plaintiff’s claim for continuing long term disability benefits. The plaintiff alleged that CIGNA had acted arbitrarily, capriciously and wrongfully by denying the Plaintiff’s claim. As such, the plaintiff is seeking from the Court the following relief:

Comments (20)

  • Grace, I am so sorry to hear what Cigna put you through. Unfortunately this is very common practice with Cigna as they try to limit most disability benefits to 2 years under the mental nervous limitation. I would agree with you that if you want to ensure you have good coverage buy your own individual policy since group coverage is not usually what people expect. I wish there was something we could do to help, but it appears that the Statute of Limitations has likely run on your claim. I wish you luck and better health.

    Rachel Alters May 17, 2020  #20

  • CIGNA used the depression against me. 1998. I was denied time after time. Primary dr, Independent Medical Exam for short term disability to continue. PSYCHOLOGIST, Neuro Psychologist, Infectious Disease Doctor, Neoroligist all determined I had Chrinic Fatigue Syndrone and Fibromyalgia. Also had secondary depression because I wanted to work and do housework and take my son to activities but had become so unreliable because of these diseases. Cigna has a fine print stating that any mention of depression. No not exact terms. But it’s been 20 years. You only get 2 years of benefits.

    4 and a half years after my disease began I finally found an ERISA attorney that defended claimants. I thought I would get back pay for there whole term. We lost our house, my son developed anxiety attacks and obsessive compulsive disorder because we lost our secure home and head to move into a trailer park. My marriage was very shaky not only because I was sick. But because I was so stressed trying to obtain any income from social security or long term disability. We had finally gotten social security income 6 months prior to foreclosure, but as soon as I told the mortgage company I was approved, they wanted the past year of mortgage payment plus 20,000 in attorney fees for all the trouble of holding my mortgage for a year with no payments.

    I also had argued to the state of Florida that Cigna’s website was fraudulent. Because at that time Chronic Fatigue Syndrome and AIDS were supposed to get specialized review. Which they didn’t give me. Functional Capacities Exam is closer generated. Even so it can not determine when I am going to hit a brick wall and have to lay flat or go to sleep. It can’t determine that, even of I can do the mowing today, it doesn’t mean I can do it tomorrow because of post exertional malaise. A 2 day FCE should be used in cases of CFS and FMS.

    The report stated I could stand for an hour, sit for 6 hours, walk for an hour. The depression was from the sudden loss of energy, the numerous symptoms that started off like a mono like flu and then added neurological, hormonal, physical, and emotional symptoms week by week. Because of LTD denials I also lost my health insurance benefits from my employer, I was terminated. On my 35th birthday. My boss had left and an interim boss was in place and they filled out my job description wrong. Looked on paper like I was a secretary. I was a level 3 manufacturing associate who worked in circuit board manufacturing. Assembly, conformal coat, wave solder, prep. I did corporate ESH audits every few months, requiring me to be on my feet at all times, organize procedures top hand out to other participating auditors. To be above top travel. Flights, rental cars, hotels all covered by the company I worked for.

    I also worked in wiring, and sub assemblies. So I didn’t sit all day every day. I did go to the person in charge of employees resources. Two months after getting sick to see if I could work around my diseases. Flex schedule is what I asked for. I was denied a flex schedule which I thought was a reasonable request. But when I complained to the state about that they decided it was unreasonable under the ADA. Ridiculous.

    Anyway. 5 and a half years after I became disabled, I walk at of the mediation with only 2 years of back pay and 33 percent going to the lawyer. I cried, of course. Not until I screamed away at the whole line of attorneys they sent after me. For racketeering and extortion. They deserved to go to jail. The mediator agreed with me, but they can’t take sides. Liars all of them. Lost my house, my family’s security, my illness got worse because of stress, trying to get what I paid for. Insurance, no assurance you’ll get it. They lied from day one at employees orientation. Saying they’d take care of us in case of injury or illness. Pretty much anyone who loses their ability to function on a daily basis is going to be depressed. I’m surprised anyone gets more than 2 years of disability from this company.

    Oh I was also given a gag order. Because of my website I had promoted, exclaiming the LTD is not an assurance of your family’s financial protection in case you get sick and can’t work like they promised. I accused them of false advertisement too. They did have to change their website! State investigated my claims of false advertisement.

    I also copied my job description off of my companies website, describing my correct job duties, had my employer investigated on fraudulent information given to the insurance company. Creating more denials. And, because I did not get a specialized review. FCE is a standard tool. You can’t use that against a disease that’s got fatigue in its name for God’s sake.

    I had to take down my website and was ordered not to tell anyone about this whole ordeal. So I am telling you this with the chance that they will sue me for damages and to return the money they owed me. Even though as far as I’m concerned, they owed me 5 and a half years of back pay. Hell, they could have gotten away with only paying the difference between what ssdi pays and what they would have owed. Once I got approved for ssdi. Yep, 2 and a half years to get that. Normally LTD is 60% of your income. I paid extra to have 70%. My spouse was not the most reliable income earner. I was the stable one out of the two of us until I got sick.

    This disease is up and down all the time. It has better spells and worse spells. Sometimes I can go for 3 or 4 days, then down for 3 or 4. Or like now, can go for 3 or 4 hours and down for days on end. Timing how long is it going to take to make dinner before I have to take a break, do dishes or not? Talk on the phone or ignore the call because I don’t have the energy or brain to put two words together or am I going to take over the conversation because my mind is going from one subject to another. Side effects from medications I’ve tried caused mania and mental fog.

    Anyway. It’s ridiculous. I finally moved back home in 2016. To this day I advise everyone who I know is still working to get their LTD through private insurance. At least they could get pain and suffering and damages that they can’t get through ERISA that now protects employers not employees.

    Grace W. May 17, 2020  #19

  • Daryal,

    Max benefits have been reached as in you reached the maximum benefit period/age (65 or your SSNRA?). If the benefits are ending because of the preceding there is little that can be done with respect to Cigna. If your claim has been denied for a different reason please feel free to contact our office to discuss same.

    Stephen Jessup Jul 9, 2015  #18

  • I have been receiving Cigna LTD since 2006. Diagnosed with Bipolar 1 disorder, Cardiac Artery Disease, anxiety, road rage, glaucoma,and was told by my doctor to never drive a semi again. Now recovering from throat cancer treatments I can’t really get out of bed still not eating solids, living off of Boost nutrition drinks. Last month June 2015 Cigna sent me a letter saying maximum benefit has been reached and discontinued my payments. At this time I am really to week to fight a run around doctors offices getting papers signed. Any help available please?

    Daryal Jul 8, 2015  #17

  • Greg,

    Have you received any indication back from Cigna? Cigna does negotiate buyouts on a case by case basis, but do not have any obligation to consider one. If they turn down your request you unfortunately have no recourse to force their hand.

    Stephen Jessup Jun 14, 2015  #16

  • I have an LVAD, (Destination not Transplant), and have passed the two year mark with it as well as with Cigna’s 2 year window on LTD. I have requested they consider buying out the remainder of my LTD since according to the contract they would be liable until I turn 65. I and my Doctors seriously doubt I’ll get there. I am 58 and as time passes the survival rate for folks like me drops dramatically. 58% @ 2 years, 42% @ 3 years, 35% of 4 years. So my question is and being that Cigna is who they are, what is the likelihood that they will buy out the contract and at what possible percentage? And if they refuse, do I have recourse?

    Thank you

    Greg Jun 13, 2015  #15

  • Jeff,

    Cigna is known for denying benefits on account of the wrong box being checked by a doctor on a form. Please feel free to contact our office with a copy of your denial letter and we will be more than willing to discuss how we may be able to assist you in appealing the denial.

    Stephen Jessup Feb 12, 2015  #14

  • I have been receiving payments from Cigna since Oct. 2013 and just received a call today to let me know that my benefits have been discontinued. I have two herniated & two bulging discs in my back along with two bulging in my neck. I also have Stenosis & Arthritis throughout my spine. My condition has not changed since they originally approved it and I am still under doctors care for the conditions. I have to still receive steroid injections periodically in my back and neck. I have been on pain meds since the condition occurred. I was told since the last paperwork was not filled out properly. I tried explain to the case manager that my condition has not changed and I have not been released from the Doctor to return to work, so how can they deny something they originally approved. I was also told by another case manager that could not deny it unless my condition improved or I was released from the doctor.

    Jeff Feb 11, 2015  #13

  • Marina,

    I strongly suggest you contact them immediately to advise them of the error they made. They should reinstate the policy based on error they made in mailing the premium to the wrong address (assuming you updated them as to a correct address).

    Stephen Jessup Jan 10, 2015  #12

  • I have a Cigna life insurance since 17 years and always paid my bills on time. Now Cigna sent me a bill but to the wrong adress and did not recieve the money, so the insurance company canceled my policy.

    Marina Jan 9, 2015  #11

  • Andrea,

    You will need to appeal the denial of benefits for the any occupation period of disability. Please feel free to contact our office to discuss same.

    Stephen Jessup May 29, 2014  #10

  • Cigna approved my appeal and sent a letter stating that per my policy they did decide I was unable to do my current position. Then I noticed I was paid for a year all at once. I tried contacting many people there, then finally was told on the phone that they determined I could not do my current job, but was able to do another job and make 80 percent of my income. I explained to the lady that I never received such a letter. I also explained that they needed to look at my policy as it states I am to be paid for 5 years if unable to do my current position. They mailed the letter, back dated to March 8th, stating I could sit for over 8 hours and could walk ocassionally therefore could do 2 possible jobs they listed.There was never a functionality test performed yet they put it in the letter as if it was. I have postural orthostatic tachycardia syndrome. I faint. They realized their mistake and admitted it is to be 5 years, but now want me to do a functionality test. All this after they said I was deemed disabled from my current position. The fact that they sent letters to me approving it, then send a letter with the wrong policy info on it only proves their incompetence. I feel I should have a witness at the functionality test which does not pertain to my illness. I can faint at anytime. it has nothing to do with lifting things and I would be a liability for any company. Not to mention could die if they send me to someone who knows nothing of my illness and I faint.

    Andrea May 28, 2014  #9

  • Bruce,

    It is always a pleasure and honor to be able to assist our clients in securing a favorable outcome. Thank you for entrusting us with representing you.

    Stephen Jessup Nov 20, 2013  #8

  • Hello,

    This same thing happened to me with CIGNA! Had Benefits since December 1999 then stopped my disability payments around the end of 2011… this even though I was still disabled through my Employer, SSDI and through the VA. CIGNA is simply unreal and the actions they take are baffling.

    I called Mr. Greg Dell… hired his law firm and my benefits were soon reinstated!

    I believe that CIGNA gets very upset when people like me and yourself. Turn to Dell & Schaefer Law Firm for help!

    Bruce A. Nov 19, 2013  #7

  • Robin,

    There are a lot of working pieces to your situation. Please feel free to contact us for a free consultation to determine how we may help you and what your options are.

    Stephen Jessup Jul 18, 2013  #6

  • Cigna denied me my Ltd for major depressive disorder, anxiety, panic disorder, migraines and PTSD. They said I had no objective evidence and that since I had a sedentary office job that I really do not have any restrictions even though my doctors feel I am still not ready to go back to work. I have had brain seizures do to the medications for my migraines and depression had a serious drug interaction that could have been potentially fatal. My job of 30 years says if Cigna denies my LTD and all 3 appeals (which I’ll be broke by then) I will be fired. Even though I have an approved medical leave from Sedgwick our insurance company has the final say over our job. Needless to say I am 3 years from full retirement. Can I quit now and get my 401k money to pay our bills and get a lawyer to help with my appeals and still sue Cigna? I can’t drag this appeal process out and lose our car and home. But they should have to pay!

    Robin Jul 17, 2013  #5

  • Lisa,

    I would suggest that you request the presence of a videoagpraher at the exam. I would also recommend that you attend with him. Be careful that Cigna is not trying to limit his benefits to 24 months by claiming he only has a mental limitation and not a physical. Contact us and we can discuss how we can assist you.

    Gregory Dell May 27, 2013  #4

  • My husband has been receiving disability payments from Cigna for 3 years now. He had a serious fall that caused a TBI and back issues. Debilitating post-concussive headaches, memory issues, personality change and drop foot… He was approved for SSDI on the first application. In three weeks he has an appointment with a neuropsychologist chosen by Cigna for an IME. I am scared to death because 4-5 days a week he is “out of it” due to his headaches and can’t answer any questions – let alone a full day of testing. I’ve heard horror stories about Cigna and we will be in a bad situation if they cancel us. Any advice? Thanks.

    Lisa Robinson May 26, 2013  #3

  • Bill,

    CIGNA probably says your SSDI approval does not matter because it was several years ago. You need to continue to fight for your benefits and submit all of the medical documentation that you have in support of your claim. Its is amazing that after 12 years of paying you that CIGNA thinks you got better and can return to work. Contact us for a free consultation if you need help with your CIGNA Disability Denial.

    Gregory Dell Oct 21, 2011  #2

  • I am also having similar problem. My company’s long term disability is handled by CIGNA. Social Security has approved my disabilty but CIGNA states it does not matter and have to appeal their decision. So in the meantime, since long term was not approved yet, they also cancelled our CIGNA medival and dental coverage for my wife and I.

    Bill Altman Oct 20, 2011  #1

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