After Two Appeals, Cigna Finally Sees the Light and Pays Disability Benefits
Author: Attorney Alex Palamara
Our client had been employed as a Truck Driver for Harris Teeter Supermarkets, Inc. His disabilities included Chronic Pancreatitis, Chronic Pain, Stomach Ulcers, Epigastric Pain, Nausea, Diffuse Gastritis, Gastroesophageal Reflux Disease (GERD), Fatty Liver, Nephrolithiasis, Type 2 Diabetes Mellitus, Hypertension, Headaches, Osteoarthritis of the Knee, Hyperlipidemia, Lumbago, Kidney Stones, and Insomnia. The client worked dutifully for Harris Teeter since 1994. Unfortunately, by the end of October 2012, the conditions and their accompanying restrictions and limitations became too much. Knowing he was covered under Short Term (STD) and Long Term Disability (LTD) Insurance Policies for this very situation, the client left work and applied for benefits.
Unfortunately for the client, Cigna denied his application for Short Term Disability Benefits. Within a week of receiving the December 19, 2012 Denial Letter, the client had contacted Attorneys Dell & Schaefer for potential representation. Dell & Schaefer quickly formulated a plan to both appeal the Short Term Disability Insurance Denial and at the same time apply for Long Term Disability Benefits. The appeal and application were timely filed.
Relying on internal reviews conducted by Cigna employees only, Cigna unfortunately not only again denied the Short Term Disability claim but also denied the Long Term Disability application. This decision was frustrating for both Dell & Schaefer and the client as the decisions appeared to have not been based on the medical records and other facts of the case. Instead, it became apparent that the decision was based on Cigna’s inherent conflict of interest as it was not only the decider of benefits, but it also paid the disability benefits.
Administrative Appeal by Attorney Alexander Palamara
A second appeal was then filed by Disability Attorney Alexander Palamara. In the Appeal, Attorney Palamara stressed the objective documentation found in the medical records and the support of the client’s treating physicians. Attorney Palamara also pointed out Cigna’s conflict of interest and noted how it appeared to be clouding the judgment of the company.
Within 45 days of the second appeal being filed, Cigna informed Dell & Schaefer that the client would be receiving the remaining Short Term Disability Benefits owed, the past due Long Term disability Benefits owed, and would be on monthly claim for Long Term Disability Benefits.
The delay in payment caused by Cigna was unjust. However, the client is happy to finally have been awarded his benefit and is looking forward to receiving his benefit until he is able to go back to work or until the policy expires.
If you have been denied by Cigna or any other disability insurance company, please do not delay and please contact Attorneys Dell & Schaefer for a free consultation and review of your claim.