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Question

What right does CIGNA have in contradicting my own medical doctors recommendation?

Asked on February 18th 2011 by Karla G.
I’m having my short term disability benefits delayed. I have a medical condition of persistant, constant severe migraines. I have taken FML earlier of 2010, and then on the 21st of Dec 2010, I was put on STD by my physician. The first requests for information from myself as well as from my physician was requested and received by me and my physician Jan. 24th, 2011, which delayed approval. Finally on Feb 7th CIGNA approved my benefit for STD payment only through to the 7th of Feb. 2011. Now being seen by an new doctor on the 8th of Feb. they have delayed getting further information to approve continuation of benefits. I have constant headaches daily, with the pain moving to a 8 or 10 on a scale of 1-10. I have been told that my blood is too thick as well as a severe vitamin D deficiency. I suffer daily with dizziness and vertego, with episodes of falling. I average three migraines a week, and some last as long as 36 hours. Now CIGNA is trying to tell me I can go to work, which is in conflict with what my doctors are saying. I suffer from insomnia, disorientation/confusion, pain, and nausea daily, which is some from the meds. My employer does not want me there at work due to being an accident liability. So what right does CIGNA have in contradicting my own medical doctors recommendation? What can I do? Where are my rights? CIGNA is adding stress which is causing me more frequency to my condition. Do you have other cases like mine where they are wrongfully non supportive of my claim?

Answer

Answered on February 18th 2011 by Attorney Gregory Dell

Karla, your situation with CIGNA is typical conduct for a disability insurance company. We have not seen your disability insurance policy so it is difficult for us to advise you of your rights. CIGNA has the right to contradict your doctors and they have their own doctors on staff. You have been paid through February 7, 2011, so CIGNA will usualy take 7-14 days to review updated medical records. Short term disability claims are very difficult when a disability carrier is asking for medical records every week. The only thing you can do at this point is to continue to send in every single medical record you have and call the carrier every day for a status. If your claim is denied, then you will have the right to file an appeal and then sue them. Your condition seems verys serious and it appears that CIGNA will continue to pay you despite their delay.

Related: CignaHeadaches & Migraines