Cigna Approves Any Occupation Disability Benefits After Two Appeals

Prior to filing for long term disability benefits with Cigna, our client worked as a coordinator for a large hospital system. After having double knee replacements he found the physical demands of his job to be too strenuous in light of his ongoing pain and movement limitations. Left with little choice he filed a claim for disability benefits with Cigna. Based on the information provided Cigna approved his claim for benefits under the Own Occupation period definition of disability and issued benefits for 24 months, at which time Cigna advised him that he no longer qualified for benefits under the Any Occupation definition of disability as it had determined he was capable of Sedentary Work duties. Like many other insureds on claim with Cigna, this determination was made despite the fact Cigna had assisted him in obtaining his Social Security Disability benefits.

The First Appeal

Like many people, our client did not initially understand the importance of an appeal under a policy governed by ERISA, and took his claim manager’s word that all he had to do was write a letter stating why he disagreed with the denial. Our client did just that and shortly after receiving the denial letter he submitted a brief appeal. Shortly thereafter he received notice that Cigna was upholding its denial of his claim for benefits as Cigna determined that our client failed to submit evidence of his inability to work at a sedentary demand level.

The Second Appeal

Following the second denial letter, our client contacted Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup. Attorney Jessup informed our client as to the nature of litigation under ERISA disability policies and how failure to provide all information necessary to prove disability on Appeal could prevent an insured from bringing additional evidence into the record at trial. Thankfully for our client his disability policy with Cigna allowed for a voluntary second appeal.

Like many insureds our client never obtained a copy of his claim file nor did he know that he was entitled to same; as such Attorney Jessup secured a complete copy of our client’s claim file and began immediately looking for ways to counter the arguments made by Cigna’s medical reviewers. Attorney Jessup also secured medical records from our client’s treatment providers and coordinated for additional testing that would help document our client’s physical restrictions and limitations and that would effectively nullify Cigna’s position that he was capable of performing full time Sedentary work. What made the case more challenging was the fact that by the time Attorney Jessup became involved our client’s claim had been terminated for nearly nine months. As such, Attorney Jessup had to not only establish physical disability at the present time but also effectively argue that the impairments being documented currently were also in effect almost a year earlier.

After all the information was gathered and arguments were finalized, Attorney Jessup submitted our client’s voluntary and final appeal. Faced with overwhelming evidence to support continued restrictions and limitations that would prevent our client from working, Cigna notified our Office that it was reinstating our client’s benefits. After almost a year without monthly benefits Cigna forwarded a check representing all back benefits owed and placed our client back on claim.

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If your long term disability benefits have been denied do not trust your insurance company that writing a simple letter will in and of itself suffice to having your benefits reinstated. Under ERISA governed disability insurance policies your Appeal will form the basis of all information you will be able to argue in the event you have to file a lawsuit, as such it is always wise to consult with an attorney before filing an appeal.

If your claim has been denied and you need to file an Appeal do not hesitate to contact our office to discuss how we may be able to assist you.

Find more articles about CIGNA disability claims on this page.

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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   *****

Monica P.

When my disability benefits were taken away, I was devastated. My benefits represented one-half of our income. After speaking with several disability law firms, I was impressed with Stephen Jessup’s knowledge, compassion, and attitude. Throughout the process of an appeal and settlement negotiations, he kept me informed on what was happening, and what the next step would be. He made sure I understood the process, and what to expect. His expertise throughout the settlement phase brought about a successful resolution that was more than I expected.

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