Prior to filing for long term disability benefits our client worked as an International Dealer Sales Manager who was responsible for a multitude of development and implement strategies relating to sales throughout all of Latin and South America. His job required a great deal of international travel, long hours, and managing a large number of sales representatives in the United States and abroad. Unfortunately, he contracted a rare form of epilepsy secondary to a meningo-encephalitic process (a sudden onset of an inflammation of the brain) that resulted in severe cognitive limitations. Compounding these problems was the fact that he was already suffering from vertigo, cervical neck issues and had a diagnosis of fibromyalgia. However, in light of the epilepsy and resultant cognitive impairment he was no longer able to meet the intense demands of his occupation.
Our client initially filed his claim for disability benefits with Cigna on his own resulting in Cigna approving his claim due to what it determined to be depression and not due to the acute nature of his physical/neurological medical condition. However, it was not long until Cigna even challenged the diagnosis of depression and denied his claim for benefits.
The First Appeal
Following the first denial of benefits our client submitted his own appeal and in doing so argued that his claim for disability was not predicated on a mental health condition, but rather based upon the documented epileptic condition and cognitive impairment. Following the appeal, Cigna overturned the denial of benefits, but in doing so again argued that the only disabling condition was depression. Cigna further argued that following a review of his claim by a physician board certified in Physical Medicine and Rehabilitation that there was no evidence of a physical medical condition that would preclude him from working in his occupation. Furthermore, Cigna asserted that a review of the medical file, as performed by a board certified neuropsychologist had determined that there was no objective or validated data contained in neuropsychological testing that that would corroborate any cognitive impairment.
The 24 Month Mental Health Limitation
Our client, happy to have his monthly benefit reinstated, did not at that time argue any further with Cigna as to the cause of his disability. His policy, like the vast majority of Cigna disability insurance policies, had a 24 month limitation for mental health conditions, which expired less than a year after his claim was overturned on appeal. Following the expiration of the 24 month limitation for mental health claims Cigna again issued a denial of benefits.
The Second Appeal
Following the second denial our client contacted Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup. In the denial Cigna again argued that there was no basis for a physical or neurological medical condition that would result in disability, or that verified any cognitive limitations as a result of same. These opinions were again based solely on file reviews conducted by doctors hired by Cigna. In preparing the appeal, Attorney Jessup noted that Cigna’s reviewing psychologist disagreed heavily with our client’s neurologist as to the nature and extent of cognitive limitations; however, the Social Security Administrative Judge, in awarding benefits to our client, relied heavily and gave great weight to the medical opinion of our clients neurologist, effectively approving the SSDI claim based on our client’s neurological conditions and not a mental health diagnosis.
Attorney Jessup also focused heavily not only on the mental demands of our client’s pre-disability occupation but also the physical demands, which were largely overlooked by Cigna in rendering its denial of benefits. Additional argument was provided that separate from our clients neurological/cognitive conditions that he would be physically prevented from performing the physical job requirements of his occupation on account of his diagnoses of cervical disc disease, vertigo and fibromyalgia. As neuropsychological testing had already been recently performed Attorney Jessup was not able to provide repeat testing to satisfy Cigna’s requirement for objective evidence, but instead addressed this issue by preparing questionnaires and obtaining statements from our client’s physicians in Florida and in Chile, to also include a statement from our client’s treating psychiatrist that cognitive limitations were a result of epilepsy and not a mental health condition.
Armed with additional evidence of disability and persuasive counter argument to Cigna’s medical reviewer’s opinions, Attorney Jessup submitted our client’s appeal. Based on the argument and information presented, Cigna overturned its denial of our client’s claim, lifted the 24 month limitation for mental health, and approved our client’s disability based on his neurological and physical medical conditions.