CIGNA overturns decision to terminate benefits of telephone sales representative with severe degenerative disc disease
CIGNA improperly terminated claimant’s disability benefits stating that the information in the claim file did not support a continued impairment to preclude her from performing her own occupation. It was apparent that CIGNA failed to consider relevant information which supported that the claimant was in fact, precluded from performing the material duties of her regular occupation.
In appealing the termination of benefits, Attorney Rachel Alters argued that CIGNA was arbitrary and capricious in terminating the claimant’s benefits when her medical records and treating physicians’ opinions were clear that she was incapable of performing full-time sedentary work. CIGNA’s disability determination was based on a selective review the claimant’s medical records. Despite the fact that the STD/LTD Plan permits CIGNA to conduct an Independent Medical Examination or Functional Capacity Evaluation, CIGNA chose not to perform any such evaluation. CIGNA’s decision not to perform any examination is significant because a dispute clearly existed between the opinion of her treating physician and that of CIGNA’s reviewing medical consultants.
The claimant’s treating physician documented that:
She had a poor outcome from her surgery and continued to be symptomatic with back pain. It was carefully explained to her that she has a collapsing deformity at the adjacent level L5-S1 and that pelvic rotation will be difficult, particularly sitting for any period of time on a regular basis. She should only be sitting for one hour at a time and then doing stretching exercises. She is incapable of doing any lifting. It was initially stated that she could lift up to 20 lbs., however, but now she is not to lift greater than 5 pounds. There is concern that a job sitting at a computer with lumbar spine hyperextension is impossible given the complexity of her spinal fusion and the residual deficits. She previously underwent injections and is reluctant to be put on high dose steroids due to possible complications and side effects. She was placed on very strict restrictions of no gainful employment where sitting is a regular part of her duties. She can sit for 30-35 minutes at a time and then would have to stand up. She will need the ability to lie flat at least every 2-3 hours given the complexity of her spinal condition. Without these limitations, she would have to be on high dose narcotics/steroids which are harmful and cause her side effects. She continues on NSAIDs which provide mild relief. She is unable to perform secretarial type duties as she can only perform computer work with sitting for only a minimal time period.
In prior office visit notes, it is documented by her physician that her back pain occurred across the L5-S1 level when she was in a sitting position and the claimant expressed her inability to work due to the sitting requirement of her job. Her physician expressed concerns regarding degenerative changes at the L5-S1 level because the CT scan performed on November 20, 2013 documented mild disc bulge at L4-5 and L5-S1 with mild narrowing of the central canal, early osteoarthritic changes in both SI joints, as well as indentation of the thecal sac at L5-S1 below the previous placed hardware. Additionally, in an office visit note from December 9, 2013, the physician stated that he believed the claimant could modify her work to get up once an hour to do stretching exercises. However, by March 27, 2014, it was clear that she experienced significant pain with activities, specifically bending, lifting and sitting, and he concluded that she was not capable of working for more than 4 hours with restrictions. On exam she was extremely uncomfortable and could not sit on the exam table, she could only lie flat. Exam revealed paresthesias in the buttocks and sciatic distribution with positive signs for sciatic tension, which followed the L4-5, L5-S1 distribution bilateral. In the standing position she was painful with flexion at 20 degrees or hyperextension. CIGNA completely disregarded the above opinions and medical records.
According to the Dictionary of Occupational Titles, the claimant’s occupation is classified as a “sedentary” occupation which requires lifting, carrying, pushing and pulling 10 lbs. occasionally, mostly sitting, and may involve standing or walking for brief periods of time. Based on the above, it was clear that the claimant was not capable of performing either her own occupation, or any gainful “sedentary” occupation.
After reviewing the appeal submitted by Attorney Alters, CIGNA overturned its decision to terminate benefits, paid her past benefits and put her back on claim. Attorney Alters will continue to manage her claim to help ensure CIGNA continues to pay her benefits.
Read more about CIGNA disability insurance claims on this page.
Resources to Help You Win Disability Benefits
Submit a Strong Cigna Appeal Package
We work with you, your doctors, and other experts to submit a very strong Cigna appeal.
Sue Cigna
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Cigna.
Get Your Cigna Disability Application Approved
Prevent a Cigna Disability Benefit Denial
Negotiate a Cigna Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Payment delays!
Cigna (NYL) denied my claim
Hold up on payments!!!
Paid Family Leave
They should all rot in hell
They will constantly come up with anything to delay paying you
Don't count on Cigna!!! You will be very disappointed!!!
They will do anything to avoid paying
Q: Why can Cigna get away with not paying me anything for my disability?
Q: Do I have to be an active employee to apply for LTD?
Q: Can Cigna refuse to give me a copy of my short term disability policy?
Q: Is my plan governed by ERISA?
Q: Can I add a physical disability claim to my mental health one without seeing a doctor (hard to get an appointment with COVID)?
Q: Do you handle CIGNA cases in Florida?
Q: How can Cigna get away with not answering my calls?
Q: Do you handle closed cases only, or open ones as well?
Is Cigna Seeking To Offset Disability Benefit by Social Security Survivor Benefit?
Is Cigna's Denial of Your Appeal Really a Denial?
What Should a Claimant Expect When Suing Cigna or any Other Disability Company for Long Term Disability Benefits?
Are Cigna Short Term Disability Denials on the Rise?
Cigna's latest strategies for handling and denying disability benefit claims
Is a Claimant's Complaints of Pain Enough to Qualify for Short or Long Term Disability Insurance Benefits?
Is My Insurance Company Allowed to Take An Offset of My Monthly LTD Benefit for Social Security Benefits My Kids Receive As A Result of My Disability?
Is My "No-Fault" Auto Insurance Settlement an Offset Under My Long Term Disability Insurance Policy?
Cigna Sued For Failing To Make A Timely Decision on Appeal
CIGNA Overturns a Waiver of Premium for Group Life Insurance Policy
Cigna Admits Error In Denying Disability Benefits
CIGNA Overturned Their Denial of LTD Benefits for Nevada Healthcare Coordinator
CIGNA Denies Technology Manager under the Own Occupation Provision & Dell Disability Lawyers Wins Appeal
CIGNA overturned previous denial of waiver of life insurance premiums
Dell Disability Lawyers successfully appeal denial of benefits to claimant with CRPS/RSD
LINA overturned its previous LTD denial for Medical Technologist
Reviews from Our Clients






