CIGNA Denies Technology Manager under the Own Occupation Provision & Dell & Schaefer Wins Appeal

Our client, Mr. N, formerly worked as a Technology Manager / Vice President for a large bank. For many years Mr. N suffered from chronic debilitating effects of multiple physical conditions and ailments, including, among other conditions, Parkinson’s Disease, Parkinson’s Dementia, Dystonia and Bradykinesia, which left him with debilitating physical and cognitive impairments. Mr. N was unwilling to give up his career and worked as long as he possibly could. Finally, as a result of these conditions and the restrictions and limitations associated with them, Mr. N stopped working completely in October 2016 and, thereafter, failed to regain his premorbid cognitive level of functioning which was crucial to his continued success in his high career as a Technology Manager, which required high level executive functioning.

CIGNA found Mr. N to be totally disabled and approved his STD claim through the 90 day maximum benefit period which ended in January 2017. With the expiration of the STD benefits Mr. N’s claim was submitted for continued payment under CIGNA’s LTD Policy, with the same definition of disability. After paying Mr. N LTD benefits for 6 months, CIGNA denied further benefits effective July 2017 on the basis that he allegedly no longer met the Policy definition of “Disability.” Specifically, CIGNA determined that “the supported restrictions and limitations do not preclude him from performing his own occupation.” After receiving the denial, Mr. N contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds, who identified several significant issues in CIGNA’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. N’s ERISA appeal with the assistance of his appeal team.

Following CIGNA’s denial of Mr. N’s claim and its apparent disregard for much of the relevant medical information regarding his multiple, chronic medical conditions, an appeal was submitted on behalf of Mr. N in January 2018, which included an Occupational Analysis completed by a vocational expert, which confirmed that Mr. N had no work functionality; medical records from his treatment providers and his the Social Security Administration claim file. Despite this wealth of support, CIGNA denied the appeal in June 2018. Undeterred, a voluntary 2nd level appeal was submitted in January 2019.

The 2nd level appeal addressed all of CIGNA’s short-comings and reasons for denial, with a special focus on CIGNA’s failure to acknowledge the documented deterioration in his physical and functional capabilities, including use of a cane and reduced fine motor activity. The appeal next addressed CIGNA’s failure to consider and/or provide an explanation as to why it disagreed with the significant findings in the Vocational Expert’s report, which made clear that Mr. N was incapable of performing the material duties of his own or any other sedentary occupation based on his documented functional restrictions and limitations. And finally, the appeal addressed CIGNA’s failure to address Mr. N’s well documented history of progressive loss of motor strength in all 4 extremities resulting in an unstable gait, episodes of freezing, multiple falls, bilateral hand tremors, decreased sensation in his upper extremities, cog wheeling, muscle rigidity and severe fatigue.

Just 8 weeks after filing his appeal, and after reviewing hundreds of pages of exhibits and medical records, CIGNA overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Mr. N’s LTD benefits. Attorney Symonds continues to represent our client to best ensure that CIGNA will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.

We have a lot more info about CIGNA disability claims on this page.

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