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:
- 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.
- 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:
- Judgment against CIGNA for the benefits payable under the LTD policy
- An award of prejudgment interest
- An award of reasonable attorney fees and costs
- Other such relief deem just and proper by the Court