After Appeal by Dell & Schaefer, Cigna overturns its decision to deny Short Term Disability Benefits
Author: Attorney Alex Palamara
In July of 2013, a woman former employed as a Planner/Scheduler contacted Attorneys Dell and Schaefer for potential representation due to the fact that Cigna had denied her continued claim for Short Term Disability benefits. This woman was forced to leave work on January 17, 2013 due to Chronic Fatigue Syndrome, Rheumatoid Arthritis, and Fibromyalgia. Fortunately for this Planner, she was covered for Short Term and Long Term disability benefits under the Hanford Employee Welfare Trust for such a situation.
Shortly after leaving work, the Planner applied for short term disability benefits, and, after a brief fight with Cigna, was initially approved for disability benefits by Cigna. Cigna paid short term disability benefits from February 22, 2013 until March 20, 2013. Unfortunately for the Planner, Cigna denied further benefits by way of a letter dated March 28, 2013. The Planner properly and timely appealed Cigna’s decision, but her appeal was denied on June 18, 2013. Fortunately for the Planner, her policy allowed for one final administrative appeal to prove to Cigna that she should be on claim.
Denied Claimant Contacts Dell & Schaefer
In July of 2013, within one month of being denied, the Planner contacted our firm for potential representation. After reviewing her claim, Attorney Alexander Palamara was confident our firm would be successful in overturning Cigna’s denial of benefits. Shortly thereafter the administrative record (claim file) was requested from Cigna and new medical records ordered from her treating physicians.
Administrative Appeal Filed
After reviewing the information gathered from the treating physicians and claim file, Attorney Alexander Palamara of Dell and Schaefer filed an administrative appeal challenging Cigna’s decision to deny benefits beyond March 20, 2013.
The appeal highlighted the Client’s supportive documentation found in her records as well as her treating physicians’ support. The appeal also pointed out the inadequacies of Cigna’s denial letter and its reliance on an “independent paper” review conducted by an independent physician consultant (Dr. Penny Chong).
Fortunately for our client, on February 4, 2014, Cigna informed our firm that its appeal had been successful. A few days thereafter, our client received a benefit check for the time period remaining on her short term disability claim. She thus received a sizeable benefit check for the period of March 21, 2013 through July 16, 2013.
Long Term Disability Benefits Should Be Coming Shortly
Now that the Short Term Disability Claim has been fully approved, our client is now eligible for Long Term Disability Benefits. Although Cigna should have approved the Long Term Disability claim at the same time it agreed to overturn the short term disability claim, we are confident that the LTD claim will be approved. Should it not be, Cigna is aware that Dell & Schaefer will fight for client’s benefits until they are approved.
If you have a similar situation or have been denied by Cigna or any of the other disability insurance companies, please contact us to see if Attorneys Dell & Schaefer can be of assistance. We always are available for a free consultation and review of your claim.