Benefits Reinstated: Dell & Schaefer Successfully Appeals Cigna’s Decision to Deny Benefits for MetroPCS Wireless Employee with HIV

Forced to leave his position in 2011 due to multiple complications involving HIV/AIDS, Back Issues, Hepatitis C, Depression, etc., a man formerly employed as an Account Service Representative with MetroPCS Wireless applied for and was initially approved for Long Term Disability (LTD) Benefits with CIGNA/Life Insurance Company of North America. These benefits were paid for 24 months as Cigna agreed that he was unable to perform the material duties of his Regular Occupation.

Change In Definition of Disability

Unfortunately for the claimant (and for most people covered under Group Disability Insurance Policies), the definition of disability in the LTD Policy (what it takes to qualify for disability benefits) changes after 24 months of benefits. Previously, in order to qualify for LTD benefits, the claimant just had to prove that he was unable to perform the material duties of his regular occupation as an Account Service Representative. After 24 months, it became harder to qualify for benefits as now the definition of disability changed to be “unable to perform the material duties of Any Occupation for which he or she is, or may reasonably become, qualified based on education, training or experience.”

This change in definition of disability is the most common time for people receiving LTD benefits to be denied by their insurer. In the case of the MetroPCS Wireless Employee, CIGNA did just that. By way of a letter dated September 19, 2013, the claimant was informed by CIGNA that as of December 17, 2013 his claim was denied as it did not believe that his conditions and their accompanying restrictions and limitations satisfied the new definition of disability that became active on December 17, 2013. In support of this conclusion, CIGNA pointed to an Independent Medical Evaluation it had conducted, as well as a Transferable Skill Analysis performed by one of its employees.

Claimant Contacts Dell & Schaefer

The day he was informed that his claim was denied, the claimant contacted Attorneys Dell & Schaefer immediately and spoke with Attorney Alexander Palamara for representation. The fact that the claimant contacted Dell & Schaefer so quickly gave his attorneys the full amount of time to put together an administrative appeal that had no chance of being denied by CIGNA. Armed with updated medical records, a functional capacity evaluation and Social Security Disability Approval, Attorney Alexander Palamara had significant ammunition to challenge CIGNA’s decision. On February 24, 2014, Administrative Appeals were filed challenging CIGNA’s denials on both the Long Term Disability Claim and the Waiver of Premium Claim for his Life Insurance.

Dell & Schaefer Successful

We are happy to report that on April 30, 2014 CIGNA informed the claimant and his attorney that both appeals were successful. CIGNA had agreed to reinstate both his LTD benefits and his WOP claim. Our client is scheduled to remain on claim until he is able to perform the duties of Any Occupation or until he is age 65. Dell & Schaefer will ensure that CIGNA lives up to the promises it contracted to make in the LTD Policy.

If you have been denied by CIGNA or any other disability insurance company (Unum, MetLife, Aetna, Hartford), 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.

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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.

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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.

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