Cigna Approves Disability Claim Following Multiple Denials

Prior to contacting Dell & Schaefer our client filed a claim for Short Term Disability benefits with Cigna under her employer’s group disability insurance policy due to Chronic Pain stemming from multiple degenerative conditions of her cervical and lumbar spine. Cigna initially approved her claim for disability benefits after review of her medical records, which included positive findings of impairment on examination, objective medical tests such as MRIs and the supportive opinion of her doctors. Despite initially approving her claim and unwavering support from her doctors, Cigna terminated her short term disability claim with just three weeks of benefits remaining after Cigna had her file reviewed by two internal medical professionals, who opined that she would be able to perform the duties of her Sedentary pre-disability occupation. In response to the denial our client quickly filed her first appeal on her own providing argument as to the denial but no new substantive medical information in support of her disability. Having fallen into Cigna’s trap her appeal was met by yet another denial from Cigna after it once again relied on additional paper file reviews performed by its doctors.

After her second denial of benefits, and still out of work due to her medical conditions she contacted Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup. Attorney Jessup advised that it would be in her best interest to file a voluntary level appeal in order to provide additional objective evidence of disability, with specific attention to having a Functional Capacity Evaluation performed to address Cigna’s position that our client had a full level of Sedentary physical ability. The FCE indicated that our client did not have the ability to work in a full time Sedentary capacity, but Attorney Jessup knew that Cigna would challenge the results of the FCE as the testing was performed almost ten months after the initial denial of benefits. Armed with the FCE results Attorney Jessup set about correlating the current FCE findings with the previously provided medical information in support of disability to draw a nexus and argue that the current testing results would have been indicative of our client’s restrictions and limitations at the time of the initial denial of short term disability benefits. Despite having the favorable FCE, multiple MRIs, X-Rays and EMG/Nerve conduction studies and the support of her doctors, Cigna, true to form, had her claim reviewed again by doctors who ignored the plethora of medical evidence and again rubber stamped the two initial denials.

The Long Term Disability Application

Faced with a final denial of her administrative appeals and her only remaining recourse for short term disability benefits being a civil lawsuit under ERISA, Attorney Jessup suggested that a separate application be made for long term disability benefits. In advising our client to file her long term disability claim Attorney Jessup knew that it would not only open the door for additional administrative appeals but it would also allow our client to bring a lawsuit for both short and long term disability benefits should Cigna continue to deny her claim. However, the advice to file for long term disability benefits despite the denial of the remainder of the short term disability period was predicated on the fact that Attorney Jessup has successfully won long term disability benefits with Cigna despite short term disability benefits having been denied.

In filing our client’s claim for long term disability benefits Attorney Jessup submitted the appeals previously filed on our client’s behalf along with updated claim forms and attending physician’s statements from her doctors. Faced with the information presented, and despite its own multiple prior denials of short term disability benefits, Cigna’s long term department approved our client’s claim for benefits and in doing so sent a check for a over a year’s worth of back benefits owed. Armed with the long term disability award letter Attorney Jessup contacted the short term disability department and demanded immediate payment of the remaining three weeks of short term disability benefits or a lawsuit would be filed. Without hesitation Cigna forwarded the remaining short term disability benefits owed to our client.

Claims Handling

Although our client’s claim has been reinstated and all back benefits owed have been paid she knows that as long as Cigna is providing benefits her claim will always be under the scrutiny that Cigna has already displayed. Attorney Jessup continues to represent our client and despite the fact her long term disability claim is still under the “own occupation” definition of disability, Attorney Jessup is already preparing her claim for “any occupation” review still to come.

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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.

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