Cigna Admits Error In Denying Disability Benefits

Our client, a former school teacher, suffering from multiple severe medical conditions including autonomic nervous system damage, small fiber neuropathy, a history of prior back surgery, and severe immune conditions had been receiving long term disability benefits through Cigna for approximately two years under his school system’s group disability policy when he first contacted our office. Like the vast majority of Cigna disability policies, his plan had a two year own occupation definition of disability, which required Cigna to determine his eligibility for disability benefits based on the inability to perform the material and substantial duties of his pre-disability occupation for the first two years of the claim. After that point the standard of disability would shift to the inability to perform the material and substantial duties of any occupation that he would be qualified to perform based on his training, education and experience. At the time of his initial contact with Attorney Stephen Jessup, Cigna was actively in the process of reviewing his claim for continued benefits under the any occupation standard of disability.

The IME and Any Occupation Review

What was most concerning to Attorney Jessup about Cigna’s any occupation review was the request made for an Independent Medical Examination (IME). Under the terms of the policy our client would be obligated to attend an IME at the request of Cigna and failure to do so could result in grounds for a denial of benefits. Requests for an IME with a doctor qualified to treat/comment on an individual’s specific medical condition are not uncommon. What made this request troublesome was the fact that the doctor selected by Cigna to perform the IME was not the correct medical specialty for our client’s conditions. The IME doctor was an orthopedic doctor, and given our client’s conditions should have been a neurologist or infectious disease specialist. Raising an eyebrows even further was the fact that our client was located only ten miles from the city of Provo, yet Cigna wanted him to attend an IME over 60 miles away in Ogden.

At that time our client decided to wait to hire our office to assist him and to address with Cigna, on his own, the concerns expressed by Attorney Jessup as they related to the IME doctor. Cigna did ultimately agree to change the location of the IME to a closer location. However, instead of having the IME performed by a Neurologist or Infectious Disease Specialist, Cigna ultimately chose to send our client to a doctor who specialized in Physical Pain and Rehabilitation. Our client would later tell Attorney Jessup that the IME doctor told him during the exam that he should have been examined by a Neurologist. Regardless, the IME doctor determined our client would have extensive physical ability in excess of light duty work, and as a result Cigna would ultimately terminate benefits after finding that our client would be able to return to work in his former light duty occupation as a teacher as well as alternate sedentary demand level jobs. What makes this determination even more absurd is the fact that shortly before the IME appointment our client was informed by the Social Security Administration that his claim for Social Security Benefits had been approved.

The Denial and Benefits Reinstated

After receiving the denial letter our client decided he could not handle Cigna on his own hired Attorney Jessup to take over his claim. Immediately, Attorney Jessup sent a letter of representation to Cigna requesting a complete copy of his claim file and informed Cigna that they were to have no additional contact with our client and that all communication was to be sent directly to our office. Attorney Jessup followed up on outstanding medical requests so pertinent records could be supplied to Cigna to refute the clearly erroneous basis of the denial. Realizing the fight that would be forthcoming and recognizing errors in the claims process Cigna notified Attorney Jessup within weeks that it was reinstating our client’s monthly benefit. 

Despite reinstating his long term disability claim Cigna is still challenging the Waiver of Premium claim attached to our client’s Life Insurance policy, which Attorney Jessup is currently appealing.

It is clear that our client should have never been denied benefits. Despite his young age, his complex medical history clearly establishes restrictions and limitations that even the Social Security Administration recognizes would prevent him from returning to meaningful employment.

This case serves as an example as to how Cigna’s review of a disability claim can be marred with clear and evident flaws, and that even when brought to Cigna’s attention, Cigna will still do little to rectify the problem. Cigna will stop at nothing to find any rationale to fit its agenda to deny a claim – even if that rationale is devoid of logic.

If your claim is being challenged, reviewed or denied by Cigna please contact our office to discuss your situation with one of our disability attorneys.

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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.

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   *****

Cheryl L.

I had an awesome experience working with Dell & Schaefer. I especially love the attorney Stephen Jessup who was assigned to my case. He was very professional, a great listener and kept me updated with the status of my case. Steve explained the entire process to me. He answered all of my questions in a timely manner. I believed that he really worked for me. I felt very comfortable and confident with Steve which enabled me to take care of my health without worries. I wished that Steve could be cloned for all areas of the legal arena. I would most definitely recommend Attorneys Dell & Schaefer.

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