Life Insurance Company of North America, part of CIGNA Corporation, sued for refusing disability insurance benefits for mentally ill teacher
Disability Insurance Attorneys Dell and Schaefer filed a Federal Lawsuit against Life Insurance Company of North America (LINA), which is part of CIGNA Corp (CI.N). The lawsuit was filed after Cigna refused to pay disability benefits to a Florida teacher forced to stop working due to mental health issues such as depression, bipolar disorder and schizophrenia.
According to the disability lawsuit, filed in the Middle District of Florida, Orlando Division, the teacher has been disabled since May of 2008 under the terms of the policy which state an employee is disabled if “he or she is unable to perform the material and substantial duties of his or her occupation, or solely due to Injury or Sickness, he or she is unable to earn more than 80% of his or her Indexed Covered earnings.”
Due to the legitimacy and severity of her condition, LINA approved the plaintiff for short term disability benefits. When the plaintiff submitted her claim for long-term disability benefits, LINA disapproved the claim, in clear violation of the policy’s stated terms and conditions. The plaintiff appealed the initial denial of benefits and LINA once again denied their claim.
As part of its review, LINA demanded additional medical records which the plaintiff provided. Although, In a May 20, 2010 letter to the plaintiff, LINA wrote, “At this time your claim has been closed and no benefits are payable.” LINA claimed the additional medical records do not provide any restrictions or limitations. LINA never had plaintiff examined by a doctor and relied on a paper review to deny disability insurance benefits.
The lawsuit states that LINA’s failure and refusal to pay the plaintiff for disability benefits constitutes a breach of LINA’s contractual obligations under the Disability Policy.
The plaintiff seeks judgment against LINA for damages including but not limited to past due contractual benefits, future benefits, interest, and attorney fees. This case is ERISA exempt. The plaintiff will be entitled to a jury trial.
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Answered Questions by Our Lawyers
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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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