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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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

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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, 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.

Dell & Schaefer Client Reviews   *****

Pat (Florida)

My experience with Dell & Schaefer, especially attorney Cesar Gavidia and his staff was excellent. I contacted Dell & Schaefer when I needed help as my disability insurance carrier terminated my benefits at the 2 year mark of my disability. I spent about 2 months putting together what I thought may be a decent appeal of that decision. However, the further I got into the workings and gaining some understanding of how the appeals worked under ERISA, I realized there was a lot at risk and only had one shot at it. I sought advice from an immediate family member who is also an attorney and was advised “get a firm that specializes in this type of work, then get the best”. Hence my decision to chose Dell & Schaefer.

Upon acceptance of my case, I felt that I was the center of attention for Attorney Gavidia. I had already used up 1/3 of the 180 days allotted to file the appeal working on my own so we were in a bit of a time crunch. Hundreds of pages of medical records the detail of the termination of benefits, my disability policy and several other different documents were delivered to attorney Gavidia. In short order those documents were reviewed and our strategy of appeal was discussed and developed. Necessary appointments and evaluations were coordinated and our appeal was submitted before the 180 days had expired. At the 45 day mark my insurer requested a 45 day extension on the decision. I was advised by Mr Gavidia’s assistant Michal who reassured me that this happens in most appeals. At the 90 day mark we received a favorable decision on the appeal, benefits were reinstated and back pay was awarded, but the story was not over.

After the initial termination of benefits by my insurer, I was alienated and expressed my desire with attorney Gavidia to try and find an amicable separation for all parties. Attorney Gavidia tactfully used some facts and disputes of the initial claim to open conversation with the insurer’s attorneys. He developed a dialog proposing, although I remain totally disabled as defined by my plan, a lump sum buy out of my future monthly disability benefits. Attorney Gavidia was successful in reaching an agreement that was acceptable to all parties and made sure that I had the final say on acceptance or not.

Thus, working with Dell & Schaefer I had my benefits, which had been terminated, restored, received back-pay for benefits that were withheld and missed, and successfully and satisfactorily “divorced” from my insurance provider in the form of a lump sum buy-out of my future disability benefits.

***** 5 stars based on 202 reviews

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