Question

Can Cigna deny my claim even after approving the same one a year ago?

Asked on May 2nd 2014 by Kelly Trujillo
My issue with CIGNA is that they denied me my short term disability claim. I am a county employee and CIGNA handles all our disability, fmla, we do not pay into CA state disability. A year ago I broke my ankle while at work and was denied workman’s comp by my employer stating it was a non occupational injury and would not accept the workman’s comp claim, I was to see my own medical dr. etc.. At that time I filed a disability claim with CIGNA who at first questioned why I was not under a workman’s comp claim, I explained to them about the denial, the claim manager had me fax over my documents showing the denial and they approved my short term disability. After returning to work, I continued to have issues with my ankle. In short, I had an MRI, I still have some damage and ligament issues that most likely will need surgery, I recently obtained an attorney to overturn the workman’s comp denial. I recently have been taken off work by my doctor because I can’t walk without pain. I filed a short term disability claim, and they are have denied it because it a was a work injury, first blaming it on a policy of my employers. But at this point I am not entitled to any workman’s comp benefits nor know if I will be in the future, I have filed an appeal, but they have basically told me that they will not approve my claim even after approving it when I first broke my ankle. Can they do this?

Answer

Answered on May 3rd 2014 by Attorney Cesar Gavidia

Kelly, If the policy indicates that it will not cover disability that is due to a workplace accident or sickness, then Cigna might be able to assert same. As you have already filed your appeal we will not be able to assist you at this point. If your claim is denied on appeal please feel free to contact our office to discuss how we might be able to assist you in litigating the matter.