CIGNA denies disability benefits yet social security disability benefits are approved
Lily Rubinstein filed suit against CIGNA Life Insurance Company of New York, Griffon Corporation Long Term Disability Plan, and Griffon Corporation Life Insurance Plan in the United States District Court of the Eastern District of New York when the insurance provider abruptly denied her disability benefits after approving short term benefits six previous times. The insurer took away Rubinstein’s disability benefits even though her condition remains the same as when they approved her claim the last six times and even though medical opinion is that Rubinstein risks a stroke if she goes back to work.
In addition, while CIGNA refused to see Rubinstein’s condition as disabling, the Social Security Administration (SSA) was so convinced of Rubinstein’s disability that by just looking at her medical records, they awarded her disability benefits without requiring her to attend a hearing on the matter. Her disability was so obvious to SSA that she wasn’t required to see an SSA physician either. And, since social security disability requirements are traditionally more stringent than private insurers, it is surprising that CIGNA refused to award Rubinstein long term disability benefits.
Rubinstein’s Background in Her Pursue of Her Disability Benefits
In 2007, Lily Rubinstein suffered a stroke that resulted in permanent brain damage. In fact, a CT revealed that Rubinstein’s cognitive condition will continue to deteriorate and that Rubinstein has an increased chance of having another stroke as a result of the first one. However, after the 2007 stroke, sixty-one-year-old Rubinstein, nonetheless, returned to work. On January 19, 2010, Rubinstein went to see her neurologist complaining that she was afraid she might have another stroke because when she was working her heart raced and she “became flushed… despite being treated” with medications to relieve these symptoms. Rubinstein’s physician determined that Rubinstein’s condition was indeed deteriorating. Three days later, Rubinstein’s employer refused to allow her to work until she was cleared “medically and neurologically.” Stating that Rubinstein’s inability to work was a result of hypertension, a difficulty in controlling blood pressure and the side effects of her medications, Rubinstein’s physician said that continuing to work increased Rubinstein’s risk of a recurrent stroke. Consequently, Rubinstein’s physician would not release Rubinstein to work.
On January 26, 2010, Rubinstein applied for short term disability (STD) under her CIGNA policy, and CIGNA requested medical records from her physician. The request was vague and Rubinstein’s doctor responded with a letter asking the insurer to identify the specific data it needed and reiterated his stance that Rubinstein should be placed on disability. After the back and forth submissions of the requested documents to CIGNA evaluators and Rubinstein’s physician, Rubinstein was awarded six terms of STD benefits until July 30, 2010 when her STD period ended.
In June 2010, with the eminent ending of her STD benefits, Rubinstein began applying for her long term disability benefits and tackled the voluminous paperwork involved in obtaining those benefits. CIGNA required Rubinstein to consult with a doctor of its choosing who reiterated the findings of Rubinstein’s neurologist. CIGNA ignored these findings and proceeded to have Rubinstein’s case evaluated by various and numerous physicians, nurses, psychiatrists and administrators until they were provided with some ammunition they could use for the denial of Rubinstein’s LTD benefits. Choosing to ignore her physical disorders, CIGNA suddenly concentrated on depression and panic disorders, which was an issue far removed from the fact that Rubinstein had previously received STD benefits that were not remotely based on any psychological conditions, but rather, were based on Rubinstein’s hypertension and stroke conditions.
Rubinstein is Denied Long Term Disability Benefits
Using a number of ruses to disqualify Rubinstein from receiving her rightful LTD benefits (everything from questioning the worsening of Rubinstein’s condition to accusing Rubinstein of fraudulently magnifying her symptoms), CIGNA terminated Rubinstein’s LTD benefits claiming that “Plaintiff’s fear of a stroke relapse is not evidence of an impairment” and proceeding to ignore Rubinstein’s medical documentation of her condition. Consequently, on August 19, 2010, Rubinstein received a benefits termination letter, which, according to Rubinstein’s disability attorney, “misrepresented the nature of Plaintiff’s medical condition, and provided no valid explanation why her application was denied.”
Rubinstein appealed the August 19 decision, providing CIGNA with more medical records, opinions from noted physicians (all well-versed in stroke), case law, and more evaluation by the insurers own doctors, nurses, and administrators, to no avail. One of Rubinstein’s physicians even stated that Rubinstein’s claim “clearly documents and confirms that if Plaintiff returns to work, her life is at risk due to the risk of a recurrent stroke.” Using its own physicians and experts findings, Rubinstein’s disability attorney questions CIGNA’s award of STD to Rubinstein, while denying LTD in the face of the fact that Rubinstein’s condition is the same now as when the insurer saw fit to award disability benefits only to deny them when she was obviously displaying worse symptoms now.
Rubinstein Receives Harassing Letters Instigating the Hiring of a Disability Attorney to Represent HER
After several harassing letters from the insurer’s representatives to Rubinstein, the insurer was informed that Rubinstein’s disability attorney would be handling all matters concerning her claim in the future. And on February 9, 2011, CIGNA denied Rubinstein’s appeal based on the review by a Mexico-trained physician who was the acting family physician for the defendant. Having totally misrepresented the issues of Rubinstein’s claim and focusing on issues that were not part of Rubinstein’s case (specifically her mental state), Rubinstein’s disability attorney points out in the complaint that the letter terminating Rubinstein’s disability benefits reinforces the “Defendant’s practice and pattern of employing knowingly deceptive and unfair tactics to terminate and deny claims… as evidenced by the June 27, 2008 ABC News Good Morning America expose[e].”
A complicated, drawn-out process, Rubinstein’s claim will now be decided by the United States District Court Eastern District of New York. Rubinstein’s complaint was filed April 7, 2011 and addresses several cause of action issues that include a cause of action for long term disability benefits, for statutory penalties, and for equitable relief for breach of fiduciary duties.
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