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.
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






