Cigna denies Herff Jones Inc. employee disability benefits after she is diagnosed with multiple sclerosis

Karen Kolesky has filed a lawsuit against Herff Jones Inc., Cigna Insurance, and Life Insurance Company of North America in the United States District Court of Utah, Northern Division in an effort to receive her long term disability benefits as promised in her employee insurance policy. In possession of an employee insurance policy from her employer Herff Jones, Inc., Kolesky applied for long term disability benefits when she became disabled in November 2009.

Cigna Disagrees with Social Security Disability Benefits Approval

Kolesky had worked for Herff Jones Inc. since 1985 and ceased working in November of 2009 after succumbing to “multiple sclerosis (MS), lesions on the brain, and enough impairment from this disease to not be able to carry out her basic duties of her job, or any other job.” Diagnosed with this condition by three physicians, Kolesky was awarded short term disability benefits from November 2009 until March 2010 and was permanently laid off from work in September 2010. Kolesky was declared disabled by the Social Security Administration (SSA) as of November 28, 2009; however, Cigna doesn’t agree with that decision. Consequently Cigna has denied Kolesky her duly appointed long term disability benefits, forcing Kolesky to support herself by incurring tax penalties for having to use her retirement fund for living necessities.

Kolesky Provides Cigna with Ample Proof of Her Disability Status

After hiring a Utah disability attorney, Kolesky appealed to Cigna for her promised disability benefits and provided a plethora of documentation verifying her disability including her medical records and the SSA evaluation and affirmative decision verifying Kolesky’s diagnosis as totally disabled. Cigna was not swayed and continues to deny Kolesky her long term disability benefits causing Kolesky’s condition to worsen to the stress her of her financial situation.

Kolesky’s First Cause of Action against Cigna

On June 16, 2011, Kolesky and her Utah disability lawyer filed a lawsuit against Cigna and her employer stating two causes of action. In the first cause of action, Kolesky and her Utah disability attorney allege that the plan administrator at Cigna “inappropriately denied her claim.” Also, in the first cause of action, she claims that Cigna breached its trustee obligation, and she requests “retroactive damages, benefits, interest, lost sums due,” and attorney’s fees.

Kolesky’s Second Cause of Action against Cigna

Kolesky and her disability attorney state her second cause of action under ERISA ยง 502(a)(3) in order to receive her “appropriate equitable relief” to “enforce the terms” of her Cigna disability plan, including “monetary damages, disgorging profits and promissory estoppels.” Since Kolesky was forced to take on penalties for dipping into her retirement fund, she and her Utah disability attorney also requesting reimbursement for that action to make Kolesky whole.

The insurer was aware early on that Kolesky suffered from MS and that Kolesky relied on the insurer for disability benefits in the event her symptoms became worse and prevented her from working. Consequently, Kolesky and her disability attorney claim that the insurer “should be stopped from denying benefits to [Kolesky] and ordered to pay all benefits and losses” to Kolesky that resulted from the insurer’s denial of disability benefits to Kolesky. In addition, Kolesky’s MS worsened as a direct result of the stress that Cigna caused her due to their denial of her disability benefits and she seeks damages for that issue as well.

Ultimately, Kolesky relies on the District Court of Utah to force Cigna to provide her “with her long-term disability benefits under [her] plan retroactive to September 1, 2010, plus all prejudgment interest, losses (i.e. retirement she had to live on) and attorney fees she incurred to force payment.”

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  • Daren,

    As indicated in our video on Multiple Sclerosis many insurance companies challenge and treat MS claims as they would a claim for chronic pain, fatigue or depression. Please feel free to contact our office to discuss how we may be able to assist you.

    Stephen JessupApr 20, 2014  #2

  • I am in Colorado and was diagnosed with MS in August of 09 when I was 46 years old. I continued to work in the communications/internet industry for the next 3 years until I felt the effects of the MS physically, mentally and cognitively along with the stress of my job were too much for me to continue. My employer’s STD and LTD carrier is also CIGNA. My circumstances are very similar to the ones mentioned in this case… SSA has currently approved me for 3 years of benefits and my understanding that this is customary and should become permanent considering my illness. CIGNA (who knows of SSA’s decision) is picking up the difference in my LTD benefits but made me fight tooth and nail to obtain that decision. My CIGNA LTD case is coming up for review at this time and I have little to no doubt they will again deny my benefits regardless of both the SSA decision and the medical opinion of my neurologist and primary care physicians. I do get some level of reassurance in reading this article/case that I too will eventually prevail in obtaining continued LTD benefits from CIGNA albeit likely having to also seek legal assistance.

    DarenApr 18, 2014  #1