Former Aegon USA employee suffering with multiple sclerosis sues CIGNA for denial of disability insurance benefits
A recent disability insurance lawsuit filed at the District Court for the Eastern District of Wisconsin can serve as an eye opener to the kind of claims handling practices that CIGNA will employ in order to evaluate a CIGNA disability claim. In L. v CIGNA Life & Health Insurance/Life Insurance Company of North America, the plaintiff filed a lawsuit under the Employee Retirement Income Security Act of 1974 (ERISA) through her disability lawyer to try and recover long term disability (LTD) benefits which she was and is legitimately entitled to. Allegedly, CIGNA Life had been relentless in denying the critically ill woman her claim despite the overwhelming medical evidence supporting her claim.
The Facts of the CIGNA disability Claim Denial
The plaintiff was formerly a group underwriter working for Aegon USA, Inc. On October 1984, she participated in a group long term disability insurance policy that was issued by the Life Insurance Company of North America (LINA) which is now merged with CIGNA. The plaintiff suffered from:
- Cervical Radiculopathy
- Chronic pain
- Fatigue
- Fibromyalgia
- Greater trochanteric bursitis
- Headaches
- Imbalance
- Impaired vision
- Insomnia
- Muscle spasticity
- Muscle weakness
- Multiple Sclerosis (MS)
On Short Term Disability:
On September 1st 2009, the plaintiff visited her attending physicians. After evaluating the plaintiff the doctor wrote a note stating that “the plaintiff will be out of work for at least 4 – 6 weeks due to increase in symptoms related to MS. She will be re-evaluated in 4-6 weeks to see if she can return to work.” At the same time, the physician asked that the plaintiff was to go on short term disability on that day as well.
The plaintiff on September 3rd 2009 ceased working and underwent several medical procedures for the treatment of her medical conditions. She was later re-evaluated by her attending physicians on September 29th 2009 who concluded that her “symptoms certainly prevent her from returning to work.” The plaintiff’s attending physicians also stated that the plaintiff was to continue on short term disability. During the same period, the dosages for her medications were also increased by her attending physicians.
The plaintiff continued her treatments for her symptoms which had increased in severity until on December 22nd 2009 her attending physician stated that the plaintiff had “been out of work on short term disability dating to September 1st 2009 “¦ Unfortunately, none of her symptoms have improved since that time”¦ She is incapable of any gainful employment at this time due to painful dysesthesias, fatigue secondary to MS and a subjective cognitive dysfunction.”
Claim for CIGNA Long Term Disability Benefits:
On January 6th 2010, the plaintiff made an application for LTD benefits by way of a telephone call to CIGNA. On the Physical Ability Assessment Form the physician stated that for an 8 hour workday, the plaintiff can only tolerate:
- Sitting: occasionally
- Standing: occasionally, very limited secondary to fatigue
- Walking: occasionally, very limited secondary to fatigue
- Reaching: never, due to weakness and fatigue
- Fine Manipulation: never, due to in coordination and fatigue
- Simple Grasp: occasionally
- Firm Grasp: never, due to weakness
- Lifting: occasionally less than 10 pounds only
- Carrying: occasionally less than 10 pounds only
- Climbing regular stairs: very limited
- Balancing: never, due to decreased balance, in coordination, gait dysfunction
- Stooping: never, due to decreased balance, in coordination, gait dysfunction
- Kneeling: never, due to decreased balance, in coordination, gait dysfunction
- Crouching: never, due to decreased balance, in coordination, gait dysfunction
- Crawling: never, due to decreased balance, in coordination, gait dysfunction
- Exposure to Extreme Heat: never
“Occasionally” in the Physical Ability Assessment Form is defined as being 33% or less than 2.5 hours of an 8 hours workday. In the Physical Ability Assessment form, the physician also stated that “this [patient] is unable to work any [occupation].”
The plaintiff on January 25th 2010 filed a Report of claim for LTD with CIGNA as suffering from cognitive problems associated with MS, fatigue, pain and MS. However, CIGNA on February 16th 2010 denied the plaintiff her claim for benefits. In the letter of denial, it was stated that the denial was based on the document reviews by both CIGNA’s nurse case manager and CIGNA’s medical director even though neither of these individuals examined the Plaintiff. CIGNA never spoke directly with the doctor and instead spoke only to the doctor’s office assistant. The denial letter also stated that the plaintiff was denied disability benefits because the assistant “noted that you are suffering from severe fatigue and could not work. She also noted that you are having an increase in your symptoms, but the symptoms were not an exacerbation of your [MS].”
CIGNA was aware that the assistant was not medically qualified to provide any medical opinions. Yet CIGNA had unreasonably relied on the information or opinions provided by her. It should be noted that by March 30th 2010 the plaintiff was actively taking twenty-two different types of medications for which twenty of them she had to take daily to treat her medical conditions. The medication taken included:
- Antihistamine as needed
- B Complex Plus once daily
- Calcium-Magnesium-Zinc tablet once daily
- Cymbalta 60 mg two times daily
- Decongestant as needed
- Detrol LA 4mg once daily
- Ferrous Gluconate 225mg once daily
- Fish Oil Concentrate 100mg once daily
- Lexapro 10mg once daily
- Lidoderm 5% patch up to 3 patches daily
- Lyrica 150mg 3 times daily
- OXcarbazepine 150mg two times daily
- Prevacid 30mg two times daily
- Red Yeast Rice 600mg once daily
- Rebif subcutaneous injections 3 times a week
- Ritalin 20mg two times daily
- Skelaxin 800mg every eight hours
- Topiramate 25mg two times daily
- TiZANidine HCI 4mg once daily
- Vitamin D 50,000 units once a week
- Zanaflex 4mg three times daily
1st ERISA to CIGNA
On April 13th 2010, the plaintiff submitted to CIGNA with written notice of her appeal of the February 16th 2010 denial. Based on CIGNA’s internal notes, it was revealed that CIGNA’s medical director, Dr McCool stated that “she was not felt to be disabled by Dr Godsall.” This is despite the fact that Dr Godsall was evaluating the plaintiff’s neuropsychological assessment and not the plaintiff’s physical medical conditions. Hence, Dr McCool concluded: “the medical review does not show a physical or functional loss to support the restrictions and limitations for the claimant’s own sedentary level of occupation.”
CIGNA notified the plaintiff on June 2nd 2010 that having completed the review of the plaintiff’s appeal, it was denying her entitlement to disability benefits because “the medical evidence fails to support your inability to perform your sedentary occupation as an Underwriting Manager.”
The June 2nd letter of denial letter also stated that CIGNA’s Medical Director reviewed a March 24th 2010 letter from plaintiff’s doctor that “states his opinion that you are unable to work due to significant fatigue, painful sensations, vision issues and muscle weakness/spasm/decreased balance related to [MS]” and falsely stated that the March 24th 2010 letter from the doctor “goes on to provide work restrictions that are consistent with sedentary work capacity.”
The September 22nd 2010 office visit notes of the physicians also revealed that the plaintiff had been denied LTD benefits in spite of the fact that the doctor had “supplied numerous documentations to support her disability.” The doctor went on to state that the plaintiff “has significant symptoms from her MS that prevent her from maintaining gainful employment.” and that “[it] is a complete mystery to me how they can deny her disability when her medical physicians have documented it so clearly.”
In a November 23rd 2010 letter sent to CIGNA, it can be seen that the plaintiff’s attending physician was clearly frustrated with the actions of CIGNA. In the letter, plaintiff’s doctor stated that “I have previously corresponded in support of plaintiff’s reinstatement of benefits and on March 24, 2010, I wrote a letter explaining the disabling nature of plaintiff’s MS. It is a complete mystery to me that plaintiff’s disability benefits continue to be denied in the face of overwhelming medical documentation supporting her disabling conditions and limitations.”
He also stated “[a]s her treating physician, I have physically examined the plaintiff and followed the progression of her MS for years and as such I am in a position to make the most informed decision about her ability to work. It continues to be my opinion that the plaintiff is completely disabled and is unable to work in any occupation. I respectfully request that you reinstate the plaintiff’s disability benefits.”
2nd ERISA Appeal to CIGNA
On November 29th 2010, the plaintiff submitted her second appeal to the denial of LTD benefits by CIGNA. CIGNA on December 2nd 2010, wrote to the plaintiff through their attorney and advised her that she should “forward any additional information you wish to have reviewed on appeal to us on or before December 23rd 2010 … If you have submitted all the pertinent information you wish to be reviewed for your client’s appeal, please contact the above listed phone number to notify us that you will not be submitting additional information.”
The plaintiff never contacted CIGNA in response to the December 2nd 2010 letter to advise it that she had “submitted all the pertinent information she wished to be reviewed” on appeal. However, she submitted additional witness statements to support her appeal on December 23rd 2010. The plaintiff however, was not aware that CIGNA was trying to preempt her appeal. CIGNA had on December 21st 2010, prior to the December 23rd 2010 deadline established by CIGNA above, denied the plaintiff her appeal and posted their reply which the plaintiff only received on January 3rd 2011.
The December 21st 2010 letter of denial mentioned that the plaintiff’s medical records were reviewed by CIGNA’s medical director and stated that “[a] review of the medical information fails to provide consistent medical evidence of a severe, functional impairment that would preclude the plaintiff from performing all the material duties of her regular occupation “¦ Although the doctor has provided restrictions of no work, at this time no documentation has been provided to support those restrictions.”
Reopening of Second Appeal
On January 5th 2011, the plaintiff demanded that CIGNA reopen her appeal and analyzed the additional witness statements that she submitted on December 23rd 2010, in accordance with the terms of CIGNA’s December 2nd 2010 letter. CIGNA on January 6th 2011 responded that “our office reviewed the information submitted on December 23, 2010. Unfortunately this new information does not change our prior determination of plaintiff’s Long Term Disability appeal.”
Following the denial of both appeals submitted to CIGNA, the Plaintiff was left with no choice and had to file a lawsuit in Federal Court seeking reinstatement of her disability benefits. As one of the largest provider of disability insurance coverage in the U.S, the CIGNA Life & Health Insurance (CIGNA Life) has the ability to make claimants fight for their entitlement to disability beenfits in the Courts after years of dragging their feet, causing anxiety to disabled claimants who really are in need of the disability benefit payments.
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
Unum is evil
Every month I get paid on a different date
They will do anything to not approve your claim
Reply
Don't trust them, they like to play games
Lyme Disease Disability Claim Denial
Disappointed with NY Life Disability Excuses
New York Life is a joke!
They FULL OF ****
Q: I filed an appeal and lost. Is it worth pursuing?
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.
Q: How can I appeal Cigna's decision if there are no written communications explanation the reasons for claim termination?
Q: Is there a process for appeals not being responded to in the time given? Also, how do I access my records?
Q: Is it worth is to go to court over $2500?
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?
Q: Do I have any options to void an agreement I signed? Can Signa offset my SSDI benefits?
Q: Can I sue Cigna even if they do end up paying me?
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







5 Ways We Help Get Your Benefits Paid
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.
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.
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.
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.
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.
Questions About Hiring Us
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.
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.
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.
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.
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.
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.