Attorney Cesar Gavidia successfully appeals Cigna claim denial after Cigna and its medical consultant deny claim alleging that restrictions were not medically supported by the medical records

Prior to his disability, Mr. F was employed as a Contractor Field Service Representative with a large aerospace company. As one of his employee benefits, Mr. F was provided with group long-term disability insurance through CIGNA. In 2011, Mr. F was involved in a motor vehicle accident and suffered fractures and injuries to his head, neck, back and femur. The doctors treating Mr. F decided to place him in a medically induced coma to properly treat his injuries. When he awoke he began experiencing terrible headaches which only worsened over time. The accident and the resulting injuries marked the end of his carrier in the aerospace field and forced Mr. F to file a long-term disability claim with CIGNA.

Initially, CIGNA seemed eager to help and even assisted him in gathering all of the necessary medical and occupational information it needed to conduct its review. After approximately 5 weeks, CIGNA approved Mr. F’s claim and began paying benefits. Over the course of the next two years, CIGNA requested little more than updated claim forms and physician forms from Mr. F’s treating doctors.

CIGNA Terminates Long-term Disability Claim Following Medical Consultant’s Review

Two years after initially approving Mr.F’s claim and finding that he was unable to perform his own occupation as a field service representative, CIGNA notified Mr. F that, due to a change in the definition of disability, it must determine whether he was capable of performing the substantial and material duties of any gainful occupation. A short time later CIGNA informed Mr. F that his claim was reviewed by an in-house medical consultant and a vocational rehabilitation specialist, and that based on their findings his restrictions were not medically supported. In addition, CIGNA informed Mr. F that its vocational specialist found that he was capable of performing at least three different “gainful” occupations. Based on the reports from their medical consultant and vocational specialist, CIGNA terminated Mr. F’s claim and discontinued benefits.

Mr. F contacted Attorneys Dell & Schaefer and retained Attorney Cesar Gavidia to represent him with his mandatory appeal of benefits. Attorney Gavidia discovered that CIGNA was aware that Mr. F was receiving social security disability benefits and had reduced his monthly disability benefits by the amount he was receiving from SSDI, yet completely ignored the SSA’s medical findings concerning Mr. F’s restrictions and limitatinos. In addition, the medical consultant retained by CIGNA never contacted any of Mr. F’s treating physicians to discuss the restrictions and limitations they imposed, and never directly examined Mr. F as part of his review.

After completing his analysis of CIGNA’s claim review and compiling all of the necessary evidence, Attorney Gavidia and his team submitted Mr. F’s appeal to CIGNA. Approximately two months after receiving the appeal, CIGNA communicated that it was overturning its decision to deny benefits, paying all benefits due and placing Mr. F on claim.

Currently, Mr. F remains on claim with CIGNA, while Attorney Gavidia monitors CIGNA and the claim to mitigate the likelihood of any future interruption in benefits.

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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.

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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.

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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.

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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.

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Gladys F.

I worked extremely hard on Wall Street for over twenty years – spending almost seventeen years at one of the biggest and most reputable firms – where in the 360 annual reviews I was consistently within the top five percent of performers. I suffered an injury while at work and had to undergo spine surgery and take medical leave to recuperate which lasted almost six months. However, that surgery didn’t do what we all expected and as time went by I got worse. The pain was too much, I was hardly able to walk, work, commute, sleep or anything. I had to be constantly drugged, having involuntary leg spasms at night that are extremely painful. Three top US Doctors agreed the only way to help me was for me to undergo an anterior and posterior spine fusion. This meant a very long and risky surgery and we didn’t know how long I would be unable to work. At that moment – I was laid off from my job.

After the 2nd surgery and until today, I continued to suffer from lots of pain, lack of mobility, depression, anxiety, inability to care for myself or my family, the painful leg spams continued and I realized my life had changed for the worse. I applied for disability insurance from my LTD carrier – this is the insurance I had been paying out of pocket for about sixteen years just in case I ever needed it. Despite all the Doctor’s reports, all the pain and suffering, the disability, medication and symptoms I have, the fact that my family has to do many things for me including help me bathe and dress and despite the fact that I’m going to need a third surgery pretty soon, the LTD carrier denied my claim. I contacted the law firm of Dell & Schaefer after conducting some research on great law firms in the US.

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