Dell Disability Lawyers Successfully Appeals Denial of Benefits to Former Clinical Therapist
Mr. S contacted our firm for help fighting CIGNA after receiving a letter cutting off his benefits. He had received less than a year of benefits when CIGNA scheduled an Independent Medical Examination (IME) due to a lack of response from Mr. S’s treating physicians.
Some carriers, like CIGNA, will immediately exercise their right to schedule an IME if they request claim forms from doctors and do not receive them. In some ways this is a good thing since there are some insurance companies that merely stop paying benefits when they do not receive requested claim forms from treating physicians. Usually, when benefits are terminated, the carrier will force the claimant into the appeals process which often leads to other problems down the road. CIGNA however, rarely wastes any time scheduling an IME. The problem in this situation is the claimant is now at the mercy of the hired physician and CIGNA will rely on whatever the IME doctor reports back to CIGNA.
Mr. S failed to show up to the scheduled IME and did not respond to any of CIGNA’S attempts to reschedule the appointment. Naturally, CIGNA ceased payment of benefits. While we never recommend simply refusing to attend an IME – given the claimant cooperation provision in most disability policies – in this case Mr. S may have avoided introducing negative reports into the file since doctors hired by insurance companies are known to often serve as a basis for a denial of benefits.
Mr. S contacts Dell Disability Lawyers following receipt of his denial letter
Rather than submit to the IME Mr. S was able to submit the Physical Ability Assessment (PAA) forms that had originally been requested by CIGNA. Unfortunately, the forms were not enough. In June 2017, Mr. S received a letter from CIGNA stating that benefits were terminated and he had the right to submit an appeal.
Mr. S contacted our office and we accepted Mr. S’s case. Our team immediately began working on Mr. S’s appeal. After reviewing the claim file and medical records it became apparent that Cigna had not given Mr. S a fair assessment. The medical records contained an abundance of evidence supporting Mr. S’s claim. The claim file contained documented errors by CIGNA including diagnoses that did not apply to Mr. S. It appeared the nurses reviewing Ms. S’s file had downplayed the severity of Mr. S’s condition such as describing significant spinal issues as merely a “lumbosacral sprain.”
The claim file also contained a report from CIGNA’S Medical Director that contained conclusions in complete contradiction with the available medical records. Cigna’s entire foundation for denying the claim seemed more and more unreasonable the more the file was reviewed.
To provide objective evidence of the extent of Mr. S’s functional limitations Mr. S underwent a Functional Capacity Evaluation (FCE). Unsurprisingly, the FCE revealed that Mr. Stewart’s functional ability was below sedentary, meaning that he was not only unable to perform his occupation as a Clinical Therapist but also any sit down job. The FCE report was submitted with the appeal, along with detailed physician questionnaires, a fully favorable Social Security Disability Award notice and a very detailed breakdown of the deficiencies found in CIGNA’S review.
Not long after submitting the appeal our office received notification from CIGNA that they would be overturning the denial of benefits and issuing all back benefits owed.
While Mr. S continues to receive benefits from CIGNA and continues to be represented by Dell Disability Lawyers CIGNA will continue to perform similar reviews as long as Mr. S is on claim. This case is a perfect example of how easy it is for your claim to be denied despite having substantial evidence of disability. It is important to always be one step ahead of the insurance company and never let your guard down.
If you have a similar case with CIGNA or any other disability company feel free to contact our office 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?
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.
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?
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?
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?
A: Mark, If you have no additional appeals your only option would be to find representation to file a federal law... Read More >
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?
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?
A: Donna, I do not know if you would have any avenues to void the agreement you signed. Regardless of agreeing th... Read More >
Q: Can I sue Cigna even if they do end up paying me?
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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Mr. S contacted our firm for help fighting CIGNA after receiving a letter cutting off his benefits. He had received less than a year of benefits when CIGNA scheduled an Independent Medical Examination (IME) due to a lack of response from Mr. S’s treating physicians.Some carriers, like CIGNA, will immediately exercise their right to schedule an IME if they request claim forms from doctors and do not recei... 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.
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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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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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Questions About Hiring Us
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.
Do you work in my state?
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.
Do I have to come to your office to work with your law firm?
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.
How can I contact you?
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.