After appeal filed by Attorney Jay Symonds, CIGNA overturned its previous denial of short term disability benefits for New Jersey Project Manager

Our client, Mr. W, formerly worked as a Senior Project Manager of an Industrial building/construction contractor. In May 2015 a number of medical issues, including chronic pain syndrome, cervical post laminectomy syndrome, cervical pseudarthrosis, as well as degenerative cervical joint disease, cervical facet arthropathy, spinal stenosis, forced Mr. W to stop working and submit his claim for disability benefits, first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. The STD coverage was funded by his employer but claims were administered by CIGNA. Mr. W’s occupation as Project Manager was physically and intellectually demanding and required regular travel and working at heights approaching 1000 feet above ground. Under his employer’s STD policy, he would be considered totally disabled if he was unable to perform the material and substantial duties of his own “regular occupation.”

After paying Mr. W for three (3) months under the STD policy, CIGNA denied further STD benefits on the basis that Mr. W allegedly no longer met the policy definition of disability. Specifically, CIGNA determined that “[t]here was no evidence to demonstrate functional impairment…[therefore] the claim remains closed and no further action will be taken on the claim at this time.” After receiving the denial, Mr. W contacted Attorneys Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in CIGNA’s denial letter and in the physician consultant’s medical reviews, and agreed to prepare and submit Mr. W’s ERISA appeal with the assistance of his appeal team. In addition, Attorney Symonds recommended that Mr. W initiate an LTD claim simultaneous with the STD appeal.

The STD appeal addressed all of CIGNA’s short-comings and reasons for denial, with a special focus on the review conducted by CIGNA’s in-house nurse consultant and CIGNA’s assessment of the material and substantial duties of Mr. W’s regular occupation. In particular, the appeal identified several mischaracterizations and misinterpretations of Mr. W’s medical records by CIGNA’s in-house medical staff. In addition, the appeal established CIGNA’s failure to recognize and address the fact that Mr. W’s regular occupation was quite complex, detail oriented and physically demanding.

Approximately 2 months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, CIGNA overturned its decision to terminate the claim and reinstated and paid Mr. W’s short-term disability benefits through the maximum benefit period. At the same time, Mr. W’s LTD benefit claim was approved and he began receiving payments avoiding an unnecessary delay or gap in monthly income.

Read more about CIGNA disability claims.

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FAQ

Do you help Cigna claimants nationwide?

We represent Cigna clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Cigna disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Cigna. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Cigna.

How do you help Cigna claimants?

Our lawyers help individuals that have either purchased a Cigna long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Cigna:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Jack B.

I called Dell & Schaefer the day I received the LTD denial letter, and immediately spoke with attorney Cesar Gavidia. From our phone conversation he understood what I was up against. After my denial I was feeling hopeless and was ready to throw in the towel. Cesar explained to me the next step was to file a lawsuit and take the case before a federal judge. We settled the case at mediation with the insurance co. rep and their counsel.

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