Attorney Cesar Gavidia Successfully Reinstates CIGNA Benefits to a Senior Systems Engineer Suffering from Migraines

Claimant in this case was a Senior Systems Engineer with the EMC Corporation. He had a long history of suffering with chronic migraine headaches. As time went by, the headaches worsened in frequency and severity and were accompanied by photophobia, phonophobia, nausea, and vomiting. In the previous two years before he filed his claim, he had also faced the stress of being diagnosed with kidney cancer and undergoing a kidney transplant.

A number of different pain relieving interventions had been utilized to try and decrease his symptoms, but none helped. The increase in frequency of the headaches, accompanied by the disabling symptoms, got to so bad that the claimant found it impossible to perform all of the material duties of his occupation. On May 6, 2016, claimant left work and filed a claim for short term disability benefits (STD).

Cigna’s Denial of Claim for STD Benefits

Cigna denied his claim for STD benefits, stating that the medical evidence did not support the claim. Cigna stated that the evidence failed to show that he suffered from “a functional impairment of such severity that would prevent [him] from performing [his] occupation as a Senior Systems Engineer.” Dell & Schaefer disability attorney, Cesar Gavidia, knew Cigna could not have come to this conclusion if it had reviewed the entire medical and occupational file. So, he filed an administrative appeal.

Appeal From Denial of STD Benefits Claim

It became apparent to Attorney Gavidia that, in its initial review, Cigna had only reviewed one office note dated May 2, 2016, from claimant’s treating physician. It should have reviewed the doctor’s entire file going back to March 2015.

Specially, Cigna stated in its denial letter that “there was no recent neuropsychological testing on file.” In fact, there was a neurological test report dated October 14, 2015. This test result confirmed that claimant suffered from a mild cognitive impairment that interfered with his ability to perform his job.

Also in the file was a note from a peer review physician verifying that claimant’s job performance had declined such that his work had requested he be evaluated and treated. Further, Cigna only contacted claimant’s new physician who had only seen claimant one time. There was no contact with the physician who had been treating claimant for more than a year before the May 6, 2016, date of his claim for STD.

Cigna ignored several other pieces of relevant information. There was no consideration of a report form a neurologist that verified claimant experienced more than 15 headaches a month. Each one lasted at least four hours. There was no consideration of the claimant’s job description and the required job duties of his occupation as a Senior Systems Engineer.

Attorney Gavidia included all the medical and occupational records in the appeal and commented on each individual piece of evidence showing how it supported the claim for STD. He also included individual attending physician statements supporting the diagnosis of Migraine with aura.

All examining physicians agreed with the diagnosis. Claimant’s condition was essentially summed up by one Attending Physician’s Statement that claimant could not perform the duties of his occupation since his headaches interfered with his ability to focus and concentrate. In addition, the doctor stated that claimant would be required to take three to four days off of work every week due to his chronic headaches.

Finally, after months of uncertainty, Cigna overturned its denial and not only paid the short-term disability benefits owed to the claimant, but also approved his claim for long-term disability benefits. Attorney Gavidia will continue monitoring this case and will provide Cigna with information it needs going forward in an attempt to satisfy the Proof of Loss requirements of the policy.

If you have been denied disability benefits by Cigna or any other disability insurance company, feel free to contact Cesar Gavidia at Dell & Schaefer for a free consultation.

Questions About Hiring Us

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   *****

Ken A.

I’VE BEEN A CLIENT FOR 5 YEARS!

5.0 stars

A CLIENT FOR 5 YEARS!

Most likely… if you are reading this now… you are searching for ‘The Right Disability Attorney’! Realizing that no professional, including Greg Dell, can make everyone happy, the attorneys at Dell attempt to. They are still representing my best interests and have literally collected every dime I am entitled to under policy. Insurance companies know that Greg Dell’s firm is large enough to have assets sufficient to fight if necessary. They won’t ‘roll over’ because they don’t have the money to stay in the ring. Your insurance company, I assure you, know who ‘Greg Dell’ is. After they receive that 1st letter from Mr. Dell, putting them on notice that they are no longer to contact you, (that ALL correspondence goes through him)… I assure you their ‘method of operation’ changes gears. Please listen to me.

It has been my experience that once you call your insurance carrier and tell them you are even ‘thinking about’ filing a claim – their ‘helping hands’ attitude changes immediately. You are no longer an asset… you have now become a ‘liability’. Your insurance carrier knows that they will never make another dime from you. From now on you will only cost them money… perhaps for the rest of your life. It’s just business folks… we try to mitigate liabilities. If they can find a way to stall, question and deny… most likely they will.

Understand that insurance companies make money three ways:

1. Collecting premiums.

2. Investing revenues.

3. Denying claims.

They have already collected your premiums and will now determine if they can justify denying your claim… they simply will.

GREG DELL WILL NOT LET THEM GET AWAY WITH THIS CRAP!

If you are a professional and find yourself in the unfortunate position of filing a disability claim – I admonish you to not try this on your own!

HIRE A PROFESSIONAL!

Your decision is whether to hire a “disability claims consultant” or an “attorney” which specializes in professional disability claims. You’d be wise to decide upon the later. The reason being an attorney has “power” and “authority” and actually “represents you”. He/she has authority (power of attorney) to actually communicate with your insurance company and do “Whatever It Takes”. A disability claims consultant does exactly that… they “consult” with “you” (not the insurance company) and make recommendations… they tell you what to say and do.

Mr. Dell notified my insurance company that my claim was legitimate and justified and that they were simply going to pay my claim. 5 years later I have received every single payment, in full and on time!

If you have not decided yet… please listen to me. You are about to step on the field of battle with Goliath. You must never forget that these insurance people are good… very good. They know what they are doing. All day long claims adjusters look for ways to deny claims. They know all the tricks. Unless you are King David… you are going to need much more than a rock.

In conclusion consider this… right now you are not looking for a friend. You need someone who knows what they are doing… and does it exceptionally well. Do yourself a favor and call Greg… call him right now. I assure you… you’ll sleep much better tonight!

***** 5 stars based on 202 reviews

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