Cigna Denies Disability Benefits, But Additional Information Could Have Resulted In A Victory

When filing a disability application or appeal it is of the utmost importance to provide the insurance company all of the relevant medical records and/or documentation supporting your disability in a timely manner.

If you fail to submit any important documents or records they will not be considered by the judge at a later date if your disability claim is denied.

This is why it is very important to have a disability lawyer guide you through the appeals process in order to determine what documentation must be submitted to ensure the administrative record is complete. You only get once chance to submit a good appeal.

Illustrating this very situation is a recent decision by The United States District Court for the Eastern District of Louisiana, where the judge ruled in favor of Life Insurance Company of North America’s (LINA) Motion for Summary Judgment.

In that case, the Plaintiff was involved in a work-related car accident injuring his neck and back. He attempted to return to work, however the pain was too great and his physicians agreed he should apply for long-term disability benefits. LINA reviewed the Plaintiff’s application for benefits as well as his medical documentation and denied his claim stating that he “lacked positive clinical measurements to support a degree of functional impairment that would prevent him from returning to work in his regular occupation.”

After his claim was denied, the Plaintiff applied to the Social Security Administration (SSA) for disability benefits with the help of his Louisiana disability attorney. Around the same time, the Plaintiff notified CIGNA that he wished to appeal their decision and submitted additional documentation in support of his disability, however, neither Plaintiff or his attorney ever informed Cigna of the pending SSA benefits application or the later decision by the SSA to approve his disability benefits.

Cigna denied Plaintiff’s ERISA appeal due to the lack of objective medical evidence and did not consider the SSA decision as they were never made aware of it. The Plaintiff declined LINA’s offer to file a voluntary administrative appeal and instead filed and ERISA lawsuit. Realizing that he had neglected to provide LINA with the SSA decision, the Plaintiff submitted the SSA decision as a part of his trial exhibit list.

The district court ruled that the SSA decision was not part of the administrative record and could not be considered.

Louisiana Federal Judge Agrees with the Cigna Denial of Disability Benefits

The court of appeals affirmed the lower court’s decision stating that: “The administrative record consists of relevant information made available to the administrator prior to the Complainant’s filing of a lawsuit and in a manner that gives the administrator a fair opportunity to consider it.” The Plaintiff had ample opportunity to supplement the administrative record with the SSA’s decision as he filed the lawsuit nearly 18 months later. Failing to provide this information to LINA before filing the lawsuit was inexcusable and therefore, the Court agreed that the SSA’s decision was not part of the administrative record and denied Plaintiff’s request to remand his case back to CIGNA for further review.

Lesson to Be Learned from this Cigna Disability Denial Lawsuit

The important lesson that can be taken from this case is that any pertinent information a claimant would like a judge to consider in any future case against their insurance company  for disability benefits MUST be submitted in a timely manner before his or her administrative record is closed.

Disability cases can involve thousands of pages of medical records and other pertinent documents. All of the documents need to be carefully reviewed to determine which documents are relevant and which are not. Once the administrative record is closed, and a disability denial lawsuit is filed, no additional information can be considered.

This is why it is extremely important to hire effective counsel to represent you who specialize in disability income claims to ensure that your administrative record is complete and that you do not end up in the same predicament as the Plaintiff described above.

Contact us for a free consultation to discuss your disability claim, denial, appeal, or lawsuit.

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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.

Reviews   *****

Dawn P.

I had to quit working after 8 years of dealing with chronic pain from 2 bulging and torn discs from an injury and failey back surgery. I was approved for Long term disability through my employer benefits, with Unum. They covered me with payments for one year, and suddenly sent a letter that their doctors disagreed with my surgeon and pain management doctors, and they felt I could go back to work full time. I hired a local attorney, trying to save some money, but I don’t think he had much experience dealing with big LTD companies such as Unum. He filed terrible appeals on my behalf with little to no effort on his part of building a good case for me. After a year of dealing with his condescending attitude and loosing my final appeal, I decided to call up Dell & Schaefer. I had contacted them a year prior when searching for an attorney. Cesar was willing to take my case and felt I had a good one. But I didn’t want to pay the percentage he was asking for if we won back then. The old saying, “you get what you pay for”, proved to be true in this case and I regretted not hiring him from the beginning!

Once I did hire him, and thank goodness he was still willing to take my case even though he was dealing with defending poor appeals by my previous lawyer, things got moving along for me. Because of his years of experience dealing with Unum, and his record of wins against them, within 6 months we had a settlement I could live with! The stress I suffered before Cesar and weight on my shoulders was gone! Cesar is a kind, caring, attorney who will fight for your rights! His assistant Michal always talked to me when I called in with questions or to check up on my case and never made me feel bad for calling. It was nothing like the previous relationship I had with my other attorney and his staff, who avoided me. Cesar explains the process well and keeps you updated on your options throughout the process. He was worth every penny!

I am grateful for their representation and would recommend anyone with an ERISA case to call him!

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