20 years of receiving disability insurance benefits and CIGNA denies woman’s benefits three separate times

A federal lawsuit recently filed in Pennsylvania against Cigna Insurance Company portrays a woman’s 21 year on and off battle with Cigna in order to maintain her long term disability benefits. When dealing with disability insurance companies, it is always a good move to have a disability attorney to handle your monthly disability payments. This is because the disability insurance companies are constantly reviewing your case and will try to look for a reason to terminate your long term disability (LTD) benefits. To them, you represent a “leak” in their bottom line, their profitability. So no matter how flimsy the reason maybe, disability insurance companies are not beneath their stations in trying cut off your long term disability payments. The case of Teann J. Scoggins v Life Insurance Company of America/CIGNA filed recently at the Distinct Court by the plaintiff’s disability attorney alleges malicious behavior on the part of the disability insurance companies.

The Facts of Teann J. Scoggins’s Case

In Teann J. Scoggins v Life Insurance Company of America/CIGNA, the plaintiff Teann J. Scoggins was employed as a program coordinator at Densply International Inc on December 11th 1987. While employed at Densply International Inc, she participated in a group long term disability income policy (LTD income policy) funded and administered by the Life Insurance Company of North America (LINA) also known as CIGNA.

On August 10th 1989, due to injuries to the plaintiff’s cervical spine which required two corrective fusion surgeries, the plaintiff was unable to carry on working for Densply International Inc. As stipulated under the terms of the LTD income policy, CIGNA waited for the 180 days elimination period to pass before beginning payment of LTD benefits to the plaintiff on February 7th 1990.

First Instance of LTD Benefits Termination

On February 7th 1994, CIGNA terminated the plaintiff’s LTD benefits on the basis that the plaintiff no longer met the definition of being disabled as she was no longer incapable of performing all the essential duties of “any occupation” for which she was reasonable qualified based on her education, training or experience. In response, the plaintiff on February 28th 1994 filed a lawsuit against CIGNA in the Court of Common Plea of York County Pennsylvania. The lawsuit was later removed to District Court for the Middle District of Pennsylvania. On December 1994, after CIGNA agreeing that the plaintiff was totally disabled, CIGNA made retroactive payments of LTD benefits to February 7th 1994 to the plaintiff and resumed her monthly LTD benefits payments.

Second Instance of LTD Benefits Termination

CIGNA, on January 31st 1999, again terminated the plaintiff’s LTD benefits by claiming that the plaintiff had the capability to perform sedentary or light work. On March 24th 1999, the plaintiff, through her disability attorney, requested a review of CIGNA’s decision to deny her LTD benefits. It was a good thing that the plaintiff’s Pennsylvania disability lawyer was able to point out several substantial flaws in CIGNA’s claim that after 9 months of reviewing their claim denial, they resumed her LTD benefits and also made retroactive payments of her LTD benefits back to February 1st 1999. It is also interesting to note that CIGNA took their time in reviewing the plaintiff’s appeal even though under the Employee Retirement Income Security Act of 1974 (ERISA), insurance companies are required to reach a determination within 45 days upon receiving the appeal request. This deadline can only be extended by another 30-60 days under special circumstances upon the request of the insurance companies.

Third Instance of LTD Benefits Termination

On March 26th 2010, CIGNA sent a letter informing the plaintiff that it was terminating her LTD benefits effective April 27th 2010 as she capable of performing a sedentary demand level occupation. One of the reasons for CIGNA making such a claim was because the plaintiff volunteered to help charities for a few partial days in 2007 and 2008.

Again through her disability lawyer, on March 26th 2010, the plaintiff appealed against CIGNA’s decision to terminate her LTD benefits and on July 21st 2010 and August 5th 2010 requested a copy of the records that CIGNA used to support its decision for denying the plaintiff’s LTD benefits. CIGNA refused to provide the records but instead informed the plaintiff on August 6th 2010, that the appeal was denied.

The plaintiff submitted her second appeal to CIGNA on September 29th 2010. she provided an additional 63 pages of medical documents that show her worsening physical condition and health. Despite the overwhelming medical evidences, CIGNA on December 20th 2010 denied the second appeal made by the plaintiff.

The Legal Action and Relief Sought by the Plaintiff

In the lawsuit, the plaintiff argued that CIGNA claim denial was erroneous and done in bad faith because:

  1. CIGNA had ignored several years of medical records that the plaintiff was permanently and totally disabled from working in any occupation. This decision was made even before the plaintiff’s disability attorney had the opportunity to additional evidence of the plaintiff’s disabilities.
  2. CIGNA ignored overwhelming medical evidences of the plaintiff’s deterioration physical and medical condition.

In view of the above mentioned reasons, the plaintiff is seeking the following:

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There are 4 comments

  • Debra,

    Please feel free to contact our office to discuss your claim as there seems to be many factors in motion.

    Stephen JessupFeb 13, 2014  #4

  • Hi John,

    I am in the process of appeal with CIGNA. I am waiting for an SSI hearing to get SSI benefits approved as well. I carried my CIGNA STD AND LTD for over two years in a professional traveling role and made a six-figure salary so CIGNA payout would be 60% and I am sure why they are fighting it. I was out on medical leave for auto immune illnesses and have some diagnosed, but progression of other issues has them still searching for other related disorders. My company gave ultimatum to return to work through relocation or accept severance. I took severance and even tried to convert my disability policy with CIGNA they said no because I had a STD claim pending. I had to use all my sick and vacation time prior to accepting the severance. I have had trouble finding the right attorney that will just take on the disability insurance with CIGNA. Most are SSI lawyers. How should I locate the right attorney? I held a six figure income role in the company am no longer with documented illnesses able to get new disability or life insurance now so this policy was the last I will ever likely have. I am 53 and under multiple physicians care to deal with spine and joint degeneration and further diagnosis of nerve related auto immune and connective tissue disease. My pain and fatigue is chronic. I am located in the very northern tip of Indiana. I thank you for any help in advance.

    DebraFeb 12, 2014  #3

  • John,

    If you don’t understand the overpayment, you need to ask CIGNA to provide you with a written explanation of the overpayment calculation. If you disagree with calculation then you need to send in a written response to CIGNA.

    Gregory DellSep 22, 2011  #2

  • CIGNA International was my STD and LTD which I applied for on 3/6/06 in Kuwait. When I returned to the States my company had me dealing with the Hartford Co. So, when the 2 year period ended I was denied further coverage. My appeal was approved, but they said I owed them an overpayment. Now back to CIGNA they told my former employer never contacted them about my injury in Kuwait 2006 (AUG) and being permanent and totally disabled. I have been out of work since 10/16/06. The third CIGNA rep I talked to informed me to talk with my former employer HR. This just doesn’t seem right, can you please help! Thanks.

    JohnSep 21, 2011  #1