Cigna Overturns Denial of LTD Benefits for Maintenance Supervisor Suffering from Serious Back Issues
An Industrial Maintenance Supervisor was forced to stop working after degeneration of the spine and several failed lumbar spine surgeries left him unable to work. His conditions were so bad that he required the use of a wheeled walker and he was left unable to sit or stand for more than a few minutes at a time. As a result of his inability to work, the former Maintenance Supervisor applied for LTD benefits with Cigna and was initially paid benefits for the first 24 months of his disability under the “own occupation” period of the policy. Unfortunately, benefits beyond the initial 24 months were denied.
In this policy that he had coverage under through his employer, what it means to be disabled changed after the initial 24 months of benefits were paid. This is common in most group long term disability insurance policies. Typically, for the first 24 months, claimants need only prove that they cannot perform the duties of their own occupation. At the 24th month mark, it gets more difficult to qualify for benefits as one must then prove that they are unable to perform the duties of any occupation for which they are qualified based on their training, education and experience. This 24 month mark is the most common point when approved claims get denied.
Claim Denial Due to Change in Definition of Disability
For the Industrial Maintenance Supervisor, Cigna initiated a review of his claim a few months prior to the “change in definition of disability” and ultimately determined that he was now capable of performing a sedentary occupation. As such, Cigna decided that he no longer met the definition of disability under the policy and denied further benefits.
In support of its decision to deny the claim, Cigna relied upon reviews by its in-house Claims Manager, Senior Claims Manager, Nurse Case Manager, and Medical Director. Each of these people were employed by Cigna. Despite the former Maintenance Supervisor’s inability to sit or stand for more than a few minutes, Cigna’s Medical Director found he was capable of frequently sitting with accommodations to change position every 30 minutes. Cigna’s Medical Director also found that the claimant possessed the physical capabilities necessary for sedentary work. Cigna also had its in-house vocational department perform a vocational analysis which identified two sedentary occupations the former Maintenance Supervisor was allegedly qualified for. Thus, Cigna concluded he no longer met the definition of disability as it believed he could do sedentary job and his claim was denied after the expiration of the first 24 months of disability payments.
Unfortunately, the former Maintenance Supervisor was barely capable of walking and unable to return to any type of full time employment, which was fully supported by all of his treating physicians. Thus, he knew Cigna’s conclusion was wrong. Upset his claim was denied and in disagreement with Cigna’s reasoning for denying his claim, he decided to find assistance with his claim and found Attorney Alexander Palamara of Dell Disability Lawyers.
Appeal by Attorney Palamara
After reviewing the denial letter by Cigna and speaking with the former Maintenance Supervisor, it was clear to Attorney Palamara that Cigna’s denial was improper and his client was unable to work due to serious and debilitating conditions. The claim file from Cigna was ordered along with our now clients past and current medical records to develop a full understanding of his conditions, his claim, the governing policy, and Cigna’s handling of this claim. After compiling and reviewing all the necessary information, it was clearer than ever that his benefits had to be reapproved. A detailed review of the claim file revealed inconsistencies in the opinion of the Medical Director who provided no support of his findings that the former Maintenance Supervisor was capable of sedentary work.
An appeal was drafted and timely filed. The appeal focused on the objective medical evidence in support of his claim, including among others, a history of 7 prior lumbar surgeries; decreased range of motion; multiple positive MRIs of the lumbar spine; positive lumbar spine CT Scan; and an abnormal gait with need for a prescribed a power operated vehicle due to an inability to ambulate more than 8 feet with the use of an assistive device. The former Maintenance Supervisor also underwent a Functional Capacity Evaluation which confirmed what his doctors’ opinions that he was not able to sit and perform sedentary work for an 8 hour work day.
The appeal also highlighted the inconsistencies in the opinion of Cigna’s Medical Director and Cigna’s questionable reliance on this opinion despite multiple supportive opinions by the former Maintenance Supervisor’s treating physicians.
Thankfully, two months after the appeal was filed, our client’s claim was reapproved 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 is unable to work at any occupation.
Our client is relieved to be back on claim and was happy to receive the benefits that he was owed since the time they initially denied the claim. Based on Cigna’s past conduct, it may make another attempt to deny benefits in the future, but Attorney Alexander Palamara will do whatever it takes to keep the former Maintenance Supervisor 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.
Resources to Help You Win Disability Benefits
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
Q: Can I add a physical disability claim to my mental health one without seeing a doctor (hard to get an appointment with COVID)?
What Should a Claimant Expect When Suing Cigna or any Other Disability Company for Long Term Disability Benefits?
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 Denies Technology Manager under the Own Occupation Provision & Dell Disability Lawyers Wins Appeal
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
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.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
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.