CIGNA overturned previous denial of long term disability benefits for New Jersey Account Manager
Our client, Mr. W, formerly worked as an Account Manager for a large entertainment Company. In May 2015 a number of co-morbid physical and psychiatric conditions and ailments forced Mr. W to stop working and submit his claim for disability benefits first under his employer’s short term disability (“STD”) Policy then continuing under his employer’s Long-Term Disability (“LTD”) Policy both benefits were administered and funded by CIGNA. Under both of his employer’s disability policies Mr. W would be considered totally disabled if he was unable to perform the material duties of his regular occupation, which was defined as the occupation he was routinely performing when his disability began.
After paying Mr. W for more than 7 months under the LTD Policy, CIGNA denied further LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, Prudential determined that “the medical records on file do not provide evidence of continuing functional deficits that would prevent you from performing your occupation.” After receiving the denial, Mr. W contacted Dell Disability Lawyers and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in CIGNA’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. W’s ERISA appeal with the assistance of his appeal team.
The LTD appeal addressed all of CIGNA’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of CIGNA’s denial. The appeal next addressed the fact that the available medical information confirmed that Mr. W suffered severe neurological injuries from a motor-vehicle accident after which he began experiencing extreme balance issues and his thinking became “fuzzy.” Mr. W’s neurological symptoms included serious problems speaking fluently, and he struggled to find correct words. Mr. W was examined by neurologist who conducted a CT scan and concluded that Mr. W suffered severe neurological deficits from the Traumatic Brain Injury (TBI) he suffered in the accident. Along with the cognitive and neurological difficulties Mr. W also suffered from serious orthopedic problems and was unable to walk any meaningful distance, his gait was extremely unsteady, and he required a cane. The appeal also addressed CIGNA’s in-house medical review and established that CIGNA’s reviewer incorrectly and unfairly determined that Mr. W was a malingerer and therefore suffered no restrictions or limitations as a result of his chronic and debilitating illnesses. Yet, the record evidence clearly establishes that each of the statements on which the reviewer based her determination was either pure speculation or contradicted by the available medical information. Accordingly, the reviewer’s opinions were fatally flawed and it was unreasonable for CIGNA to rely on them in support of its denial of LTD benefits.
Five months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records as well as the expert reports, CIGNA overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. W’s LTD claim. 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 on this or any matter relevant to your disability claim.
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I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
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This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.