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 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.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

Paul L. (New York)

Words can only scratch the surface regarding my experience working with Attorneys Dell & Schaefer. It’s a very emotional experience making the decision to utilize disability insurance. The unknowns were/are scary. From the very first phone call, the support staff was/are very professional and reassuring. I have been working with Attorney Steven Dell for approximately 10 years. He is confident, reassuring, listens to and addresses all my concern, and is extremely dilligent in understanding my specific policies for how they impact me. It is very reassuring that Steven handles and deals with the insurance company on my behalf. Attorney Dell’s team, and specifically Merlin, Attorney Dell’s assistant, is simply fantastic. Her professionalism and attention to detail have made all my communications with the office seamless.

Simply put, my experience with Dell & Schaefer made the emotional rollercoaster experience of my neck surgery seem like a walk in the park.

Thank You, Thank You, Thank You, to both Attorney Steven Dell and to Merlin for how you have helped me over these past 10 years.

Dilligence, Reassurance, Professionalism at every step, Confidence, Results.

With 10 years experience with working with Dell & Schaefer, taking that step to call Attorneys Dell & Schaefer was one of the best professional and personal decisions I have ever made.

You want to know what you can do – the below comment about posting your first name and last name initial on our website. Put up my full name, phone number, and email address. I will gladly speak to anyone about your office and tell them my story and how instrumental Steven and Merlin have been in my life over the past 10 years.

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