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.

****

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.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

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.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us