Cigna reinstates LTD claim after reviewing Dell Disability Lawyers appeal
Mr. M contacted our firm after receiving a letter from his disability insurer that he no longer qualified for disability benefits under his employer sponsored LTD plan. Cigna, also known as Life Insurance Company of North America (LINA), had paid disability benefits to Mr. M for two years due to his inability to work as a Process Operator for Formosa Plastics Corporation, USA. Mr. M suffers from a host of medical conditions including Chronic Pain Syndrome, various spine issues at all three levels, migraines, hypertension, as well as sleep disorders and gastro intestinal issues. During the first two years on claim Mr. M’s LTD policy required him to be unable to perform the material duties of his regular occupation as a Process Operator. However, like many group disability policies, the definition of disability changed in his policy after 24 months of benefits.
CIGNA’s Initial Decision to Deny LTD Benefits and the Decision to Contact Dell Disability Lawyers
After paying Mr. M benefits for 24 months, Cigna found that Mr. M was capable of performing an occupation at the sedentary exertion level. Cigna’s decision was based on a Peer review and Independent Medical Examination (IME). Based on these findings, Cigna found that Mr. M should be capable of performing certain sedentary occupations including that of a Maintenance Service Dispatcher or a Work Order Sorting Clerk. When Mr. M contacted our firm, he was also receiving social security disability benefits for the same disabling conditions. After speaking with us, we decided to take on the case and help Mr. M appeal Cigna’s decision to terminate Mr. M’s claim.
Appeal of CIGNA’s Denial
After receiving a copy of the claim file from Cigna, our team reviewed the IME report and Peer Review Report on which Cigna relied and a plan of action was set in motion. It soon became apparent that Cigna’s Peer Review was insufficient to support the conclusions reached in the Peer Review Report.
The Peer Review had been performed by Cigna’s hired medical consultant, Dr. Jaime Lewis. Upon reviewing Mr. M’s medical records, Dr. Lewis acknowledged that the records indicated physical dysfunction but concluded that Mr. M could lift, carry, push and pull 20 pounds occasionally. He could allegedly sit 60 minutes continually up to 8 hours per day with the ability to alter standing and walking as needed. He could allegedly stand and walk 10-15 minutes at a time up to 3 hours a day. He could allegedly reach overhead and below waist occasionally. He could allegedly reach at desk level, handle, finger, feel, and simple grasp unrestricted.”
Based on the above restrictions, Cigna determined that Mr. M was capable of performing at the Sedentary level of functioning. Interestingly, Dr. Lewis specifically stated that it is unlikely that that Mr. M would have the ability to return to full-time employment without restrictions given his history of cervical fusion.
In support of Mr. M’s appeal, Dell Disability Lawyers obtained custom questionnaires from Mr. M’s treating physicians specifically addressing the gaps in Mr. M’s medical records as well as the issues in Cigna’s review. Ms. M’s treating physicians provided detailed explanations corroborating Mr. M’s disability.
Cigna and its Peer Reviewer had overlooked or ignored the fact that the most recent medical records showed that Mr. M’s disability had progressed for the worse in his upper extremities and that his condition would preclude him from working any type of sedentary job. The evidence clearly indicated that Mr. M’s functioning in his cervical spine has continually deteriorated.
In addition to the Peer Review Report, Cigna relied on an old IME report it had performed months before the 24-month mark which concluded that Mr. M could perform sedentary work. However, the IME report documented a less than thorough evaluation.
Dell Disability Lawyers argued that if Cigna had been interested in obtaining the most accurate assessment of Mr. M’s true functional limitations then a Functional Capacity Evaluation (“FCE”) would have been requested. But Rather than requesting a functional capacity evaluation, Cigna chose to rely on a peer review and independent medical evaluation to determine Mr. M’s functional limitations.
Since Cigna did not request one and to provide more objective evidence of Mr. M’s functional limitations, Dell Disability Lawyers had Mr. M undergo an independent FCE to provide additional support for Mr. M’s claim. The results of the FCE confirmed that Mr. M has a less than sedentary level of work ability. The FCE report along with custom questionnaires from treating physicians and a thorough outline of the objective or clinical evidence corroborating Mr. M’s disability claim were submitted to Cigna in support of the appeal.
CIGNA Reinstates the LTD Claim
After reviewing the appeal submitted on Mr. M’s behalf Cigna had no choice but to reinstate Mr. M’s LTD claim. Our office was notified by phone that Mr. M’s LTD claim had been reopened and all back benefits due to Mr. M would be paid.
Dell Disability Lawyers continues to manage Mr. M’s claim with Cigna to ensure Mr. M has the best chances of staying on claim for as long as he remains disabled under the terms of his disability plan.
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Policy Holder Rating
All I need is unpaid leave for about 50 hours not 12 entire weeks. Worst customer service in history of time.
I can not stand their horrible business practices. Cigna is a bunch of mean jerks that reduce their liabilities by any means.
I don’t think it is right for Cigna to require you to apply for SSDI and even assist with the process and then after approval from SSDI drop you
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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.
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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.