Throughout our website there are multiple articles and videos regarding the seemingly endless stream of disability insurance claim denials from the Life Insurance Company of North America, or more commonly known in the disability insurance realm as Cigna. We have often said that dealing with an insurance company to secure a disability insurance benefit can be a war of attrition. If that is the case then our client’s claim is a testament to the persistence and patience required to win that war.
Our client, a former business executive and company President suffering from Meniere’s Disease and resultant vertigo, was forced to step down from his very demanding work duties in early 2015 despite multiple attempts to continue to work through his symptoms to be a driving force of his company. It would seem obvious to anyone that a person who had worked tirelessly for decades to reach the pinnacle of their career would not simply walk away from it in an attempt to collect disability benefits that represent a fraction of one’s earnings unless he or she was too sick to continue to work. However, as is often the case with Cigna, common sense seemingly had no place in their review of our client’s claim for disability insurance benefits.
Short Term Disability
Our client’s first denial of benefits came shortly after his initial application for short term disability benefits. In denying his claim Cigna argued that there was no objective medical evidence to support his subjective complaints of dizziness, lack of balance and vertigo associated symptoms, and therefore no information to justify our client’s inability to perform his “sedentary” level demand work duties. Upon receiving the denial letter, our client quickly appealed Cigna’s decision on his own. His appeal was soon thereafter met with another denial from Cigna.
Following the denial of his first appeal, our client contacted Dell & Schaefer and spoke with Attorney Stephen Jessup to determine his legal rights and options going forward. Attorney Jessup recommended filing a voluntary second appeal of the short term disability denial in order to provide as much additional medical proof in support of disability, as well as additional argument as to entitlement to benefits. In preparing the second appeal, Attorney Jessup focused a large part of his attention on the vocational reviews conducted by Cigna. As noted above, in denying our client’s claim, Cigna reviewed the material duties of our client’s occupation to simply be the ability to perform at a Sedentary demand level as set forth by the Department of Labor. Attorney Jessup noted that although all occupations require some requisite level of physical ability for the execution of job’s duties, this ability was in no way indicative of the actual material duties required of a person whose job it was to play an integral part in the running of a large corporation. To minimize his occupational duties down to the ability to sit at a desk and lift up to ten pounds was not only insulting but blatantly wrong. Armed with a thorough analysis of our client’s occupational duties, to include detailed letters from his former colleagues, as well as additional supportive statements and medical records from his doctors, Attorney Jessup submitted our clients appeal.
Despite the additional information provided in the second appeal, Cigna upheld its denial of our clients claim for short term disability benefits. With the denial, our client’s only option to secure the short term disability benefits at that point was the filing of a lawsuit under ERISA. However, before filing a lawsuit, Attorney Jessup discussed with our client the option of applying for long term disability benefits. Although it would seem that Cigna would only deny the long term disability claim in the same manner as it had the short term disability claim, from experience, Attorney Jessup knew that it was possible Cigna’s long term disability department would approve benefits.
Long Term Disability Benefits
Attorney Jessup filed our client’s application for long term disability benefits with Cigna’s LTD department and in doing so provided all information previously submitted in the prior short term disability appeals, along with updated claim forms and medical records. Cigna’s long term disability department conducted a lengthy review of the information but ultimately denied our client’s application for long term disability benefits. In denying the claim, Cigna essentially made the same arguments it had previously made throughout the short term disability denial period. The denial of the application prompted another right to appeal. Attorney Jessup again prepared and submitted another appeal of Cigna’s denial and in doing so advised our client that the likelihood of having to file a lawsuit under ERISA for the short and long term disability benefits was becoming more a reality.
Within the 45 day deadline allotted by ERISA to render a decision on the appeal, Cigna advised Attorney Jessup that it was overturning the denial of our client’s claim for long term disability benefits, placing our client on claim, and issuing back benefits owed, which amounted to almost 24 months of benefits. Attorney Jessup in turn submitted the LTD approval letter to our client’s short term disability claims manager as proof of disability and demanded all past due short term disability benefits to be promptly paid.
Persistence and Patience
Our client’s two year battle to win his benefit and to vindicate himself with Cigna, required a great deal of persistence and patience. Many insureds faced with denials from their disability insurance carriers feel defeated and often decide not to continue to pursue their claims. Although the road can be very difficult our client’s disability claim serves as an example that the fight can most certainly be won.