Cigna Again Reinstates Claim of Archdiocese of Baltimore Registered Nurse Thanks to Appeal by Dell & Schaefer

A Registered Nurse was initially forced to stop working in 2013 due to various conditions, including: enthesopathy in the hip region, lumbago, myalgia/myositis, lumbar spondylosis, lumbar degenerative disc disease, lumbar facet syndrome, and chronic pain syndrome. When the pain from her multiple medical conditions left her unable to work, the RN immediately applied to Cigna for STD benefits, but was initially denied. At that time, Cigna claimed there was insufficient evidence to support her disability, noting a lack of objective medical evidence and diagnostic tests to support her claim.

Unfortunately, the former RN was unable to work and knew Cigna’s conclusion was wrong. Dismayed her claim was denied and confused by Cigna’s rationale for denying her claim, she decided to find assistance with her claim and found Attorney Alexander Palamara of the Dell & Schaefer law firm. The former RN made the right decision, because Cigna’s denial of her STD claim would only be the first of many denials of the RN’s claims for disability benefits despite worsening medical conditions and additional diagnoses of systemic lupus erythematosus and peripheral vascular disease.

Dell & Schaefer Gets Involved

After reviewing Cigna’s claim file and speaking with the former RN, it was clear that not only had Cigna improperly denied her STD benefits, but that her claim for LTD would likely be improperly denied despite sufficient medical evidence to support the former RN’s claims for both STD and LTD benefits. As anticipated, the former RN’s LTD benefits were denied in May of 2014.

The claim files regarding the STD and LTD benefits from Cigna were ordered, as well as the updated records from our now client’s treating physicians. After compiling and reviewing all the necessary information, it was clear that benefits should be reapproved since our client had overwhelming support from her primary care physician and supportive diagnostic studies. To provide additional support to Cigna of her claims, the former RN also underwent a Functional Capacity Evaluation. Two appeals were then filed on behalf of the former RN, one for STD benefits and one for LTD benefits. The appeals focused on the objective medical evidence which supported the existence of our client’s medical conditions, but also critiqued Cigna’s failure to obtain any type of objective medical opinion regarding our client’s conditions and highlighted the improper standards used by Cigna to justify its denials.

As a result of the STD appeal, Cigna overturned its denial and STD benefits were paid in full. As a result of the LTD appeal, Cigna also overturned its denial and commenced payment of LTD benefits. However, the work was not over for Attorney Palamara since it was clear our client would not be returning to work and it was likely Cigna would make another attempt to deny the claim for LTD benefits.

Once again, as anticipated, in July of 2016 Cigna notified the former RN and Attorney Palamara that the claim was approaching the “change in definition” date under the policy and her claim was being reevaluated to determine whether the former RN was capable of performing “any occupation” instead of her “own occupation.”

Despite providing updated medical information and all necessary paperwork to Cigna, Cigna once again denied LTD benefits to the former RN. However, in support of the denial after the change in definition of disability, Cigna had the former RN undergo an independent medical evaluation, making the denial more difficult to overcome.

Despite Cigna being able to rely on the results of the IME in support of its denial, Attorney Palamara diligently reviewed all the updated medical information and claim file to find the medical records revealed consistent exam findings which supported the former RN’s credible complaints of severe, refractory pain. The results of Cigna’s IME also showed the RN was credible. Attorney Palamara highlighted the records evidencing subjective complaints and argued they must be considered in evaluating disability. Attorney Palamara also argued a claimant cannot be required to produce “objective” evidence or measures with regard to pain complaints.

This first appeal after Cigna’s denial due to the change in definition of disability was denied. In its second denial letter Cigna relied upon the review by one of its in house Medical Directors and concluded a review of the medical information on file failed to provide a physical impairment or clinical findings indicative of a functional loss to preclude the former RN from performing the duties of any occupation.

Attorney Palamara once again obtained updated medical information from our client’s treating physicians and reviewed Cigna’s claim file. Upon review of all updated information, It was clear Cigna did a poor job in relying upon the opinion of its medical director, who was advised by our client’s treating physician that she is unable to work due to chronic pain and the side effects from prescribed pain medication. The medical director did not provide any explanation for ignoring the information from our client’s treating physician, but merely cited to a lack of consistent or credible medical documentation to support functional limitations due to narcotic pain medication, consistent findings of normal mental status, and a lack of consistent side effects noted from the pain medication. The medical director’s opinion was clearly false or misleading based upon a review of the medical records.

A second appeal was filed and three months later, Cigna overturned its denial. Although our client endured numerous denials by Cigna, she is now happy to be receiving benefits once again. Attorney Palamara continues to represent our client to best ensure that Cigna will not terminate benefits once again.

Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.

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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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