Cigna Overturns Denial of LTD Benefits to Computer Systems Engineer after Appeal and Independent Medical Examination

Our client was previously employed as a Computer Systems Engineer. In this occupation, he was responsible for support and maintenance of a real-time system that allows pipeline controllers to monitor pipelines across the United States. Unfortunately for him, he was suffering from Lumbar Discogenic and Facetogenic Pain, Lumbar Radiculopathy, Cervical Spine Pain Status Post Fusion, and Piriformis Syndrome, and required narcotic pain medication. Due to his various conditions, he was unable to continue to work and he therefore filed a claim for LTD benefits under a policy he was covered under by way of his employment. Unfortunately, his claim was denied by Cigna who found that he simply did not meet the definition of disability.

In addition to his physical conditions, the claimant was also suffering from severe cognitive deficits as a result of the narcotic pain medication he needed to control his constant and severe pain. Additionally, he was scheduled for an additional back surgery, and as a result, he was unable to return to any type of full time employment. Although his claim was denied, he knew he couldn’t work and he knew Cigna’s conclusion was wrong. As such, he decided challenge this denial by filing an appeal on his own appeal. The claimant provided Cigna with additional medical records and argued his denial should be overturned because the narcotic pain medication caused cognitive deficits. Unfortunately, his appeal was denied.

In denying the appeal, Cigna once again denied LTD benefits despite a finding by Cigna that he was eligible for Waiver of Premium benefits on a life insurance policy based on the same disability. Neither Cigna nor its claim file reviewers provided a reasonable rationale for its contradictory conclusions regarding the claimant’s disability. Cigna also failed to perform a Functional Capacity Examination (FCE) or Independent Medical Examination (IME) to obtain a true assessment of the claimant’s residual functional capacity, even though the policy governing his claim allowed Cigna to have such an examination conducted.

Upset his appeal was denied and still unable to work, the claimant decided he needed assistance with his claim and found Attorney Alexander Palamara of Dell Disability Lawyers.

Appeal by Attorney Palamara

After reviewing the denial letters, speaking with the claimant, and reviewing the claimant’s appeal, it was clear to Attorney Palamara that Cigna’s denial was improper and that his now client was unable to work. The claim file from Cigna was ordered along with our now clients past and current medical records. Those documents were reviewed to develop a full understanding of his illness, claim, policy, and Cigna’s handling of his claim. After compiling and reviewing all the necessary information, it was clearer than ever that his benefits should be approved.

A detailed review of the claim file revealed Cigna found the claimant disabled under its waiver of premium provision for the Life Insurance Policy, but there was no rationale for its contradictory conclusions regarding his disability under the LTD policy. The review also revealed that Cigna failed to perform a thorough review of Mr. Dehart’s medical records and failed to have a medical doctor of the appropriate specialty perform an examination. Instead, Cigna relied on an inadequate and incomplete paper review and a flawed vocational analysis.

An appeal was drafted and timely filed. The appeal focused on the objective medical evidence in support of his claim, highlighting individual records that contradicted specific allegations by Cigna in its denial. Also included were physician statements that the claimant was limited from prolonged sitting, standing, walking and records showing that his necessary medications affected his cognition, memory and decision making skills. The appeal also highlighted the inconsistencies in the opinion of Cigna finding the claimant disabled and eligible for waiver of premium benefits, but not disabled for LTD benefits, and the failure of Cigna to perform an IME in light of conflicting findings between the claimant’s treatment providers.

Claim Approval

After filing the appeal and providing Cigna with ongoing, updated medical records, Cigna noticed the claimant for an Independent Medical Examination (“IME”). The IME was coordinated through Attorney Palamara and took place roughly 4 months after Attorney Palamara filed the second appeal on the claimant’s behalf. One month after the IME was completed, Cigna overturned its denial. Our client’s claim was approved and all back benefits that were owed were paid in full. With the assistance and support of his treating providers and their medical records, Attorney Alexander Palamara was able to successfully argue to Cigna that our client was disabled under the terms of the policy.

Our client is relieved to be on claim and to have received all the money that he was owed. Cigna attempted to deny our client’s claim without conducting an IME and properly investigating his claim, but Attorney Alexander Palamara was successful by providing updated medical records and highlighting the legal deficiencies in Cigna’s denial. Attorney Palamara will continue to do whatever it takes to keep the former Computer Systems Engineer on claim until he is able to return to work or until his policy expires.

If you have been denied disability benefits by Cigna or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer for a free consultation.


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Answered Questions by Our Lawyers
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Showing 8 of 48 Answered Questions

Q: I filed an appeal and lost. Is it worth pursuing?

Answered on September 29th 2017 by Attorney Stephen Jessup
A: Kim, in my opinion, yes. If you are still within your timeframe to file a lawsuit you have little to lose in t... Read More >

Q: Do I have a case for STD? I was denied twice because a) I hadn't been a fulltime employee for 6 months and b) I had ben on FMLA since Febury.

Answered on August 28th 2016 by Attorney Alex Palamara
A: Frank, we would need to see a copy of the denial letter and the policy. Please feel free to contact our office... Read More >

Q: How can I appeal Cigna's decision if there are no written communications explanation the reasons for claim termination?

Answered on October 20th 2015 by Attorney Alex Palamara
A: Tret, Cigna will be required by law to provide you with a written denial letter setting forth its reason for t... Read More >

Q: Is there a process for appeals not being responded to in the time given? Also, how do I access my records?

Answered on September 29th 2015 by Attorney Stephen Jessup
A: SB, ERISA provides 45 days to render a decision on appeal with the possibility of a 45 day extension- basicall... Read More >

Q: Is it worth is to go to court over $2500?

Answered on August 8th 2015 by Attorney Alex Palamara
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Q: How long will it take Cigna to get back to me? Will my military retiree pay be held against my policy 60%? Will Cigna exploit the disparity in the medical community over my illness?

Answered on August 6th 2015 by Attorney Stephen Jessup
A: Craig, Unfortunately it can sometime take up to 45 days to receive a decision from Cigna as to your entitlemen... Read More >

Q: Do I have any options to void an agreement I signed? Can Signa offset my SSDI benefits?

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Q: Can I sue Cigna even if they do end up paying me?

Answered on March 10th 2015 by Attorney Stephen Jessup
A: Linda, If your policy is governed by ERISA you will need to go through the administrative appeal process prior... Read More >
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Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.

Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

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If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.

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98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

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Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

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Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

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Who are Dell Disability Lawyers?

We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

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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 insurance 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.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. 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.

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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.

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