After receiving benefits for only 2 months, a retail clerk responsible for processing manufacturer returns was denied continued Long Term Disability Benefits by Cigna. Though she suffered from arthritis, chronic knee pain, chronic back pain, depression, anxiety, and bipolar disorder, Cigna felt justified in its denial of her claim.
In its denial letter, Cigna stated it relied upon reviews by its own employees and made the determination that there was no support for any physical limitations and no restrictions from a psychiatric standpoint.
After receiving her denial letter, the retail clerk contacted our firm and spoke with disability insurance attorney Alexander Palamara. A detailed conversation with the claimant regarding her medical conditions and a review of the denial letter made it clear that Cigna had improperly denied benefits to a woman who was suffering from severe medical restrictions based on her diagnoses.
Dell & Schaefer Gets Involved
After the initial consultation, Attorney Alexander agreed to take on her case and help her fight to get back on claim. Updated medical records and the claim file were ordered to asses our client’s current medical condition and prove to Cigna that she is incapable of performing her own occupation. A review of the claim file revealed that the Cigna employee reviews were filled with factually incorrect information. The reviews by the Cigna employees claimed the opinions by our client’s treating providers were not supported by acceptable clinical diagnostic testing; however, our client’s medical records contained ample supportive and objective clinical diagnostic testing, suggesting the Cigna employees never even reviewed our client’s records or were grossly mischaracterizing the contents of the records. It was clear that instead of looking for items in our client’s medical records that supported the claim, the Cigna employees were simply looking for what wasn’t included as an excuse to terminate her continued benefits.
The Filing of the Administrative Appeal
After gathering all necessary documentation, a timely administrative appeal was filed. This appeal challenged Cigna’s unsupported conclusions, cited to the supportive and objective medical documentation, and criticized the reviews by Cigna’s employees. The appeal also addressed the fact that medical records, especially psychiatric records, are not written for the purpose of proving a disability claim as they are written to treat the patient. The appeal pointed out that Courts have stated in the past that the use of a paper review performed by an inherently biased employee who has never met with, spoken with, or laid eyes on a patient has very little credibility, especially in the context of psychiatric evaluations because the specialty is dependent upon interviewing and spending time with patients.
Roughly 2 months after the administrative appeal was filed, Cigna reinstated our client’s long term disability benefits. Although our client went nearly seven months without benefits, she is relieved to be back on claim, and our firm is committed to do whatever it takes to see that she remains on claim until she reaches age 65.
This claim is another example of how insurance companies ignore supportive documentation and hire unqualified and biased employees to deny a claim.
If you have been denied disability benefits by Cigna or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.