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CIGNA/LINA sued for denying waiver of life insurance premium to caretaker of disabled and mentally challenged adults

After repeated appeals asking CIGNA / LINA to change their decision regarding denial of waiver of life insurance premiums due to total disability, Wendy Magee was recently forced to hire Michigan disability attorneys and file an ERISA disability lawsuit in the Federal Court of the Western District of Michigan.

Ms. Magee worked as a Home Coordinator with the Hope Network. The Hope Network is a non-profit organization that provides specialized care for individuals suffering from brain and spinal cord injuries, mental illness, developmental disabilities and other disadvantages. In her employment, Ms. Magee gave physical care to disabled and mentally challenged adults. The Hope Network provided its employees with an employee benefit plan that included Long Term Disability Insurance and a provision that provided for a waiver of premiums of their life insurance benefits should an employee become disabled.

On January 20, 2008, Ms. Magee suffered a serious injury after she fell down the stairs of her home. She was diagnosed with a compression fracture at T10-T11, thoracolumbar back pain, chronic cervicalgia, cervical facet arthropathy, degenerative disc disease, spondylosis, discogenic back pain, headaches, carotid artery disease, osteoporosis, and depression/anxiety due to the chronic pain.

After initially being awarded long-term disability benefits, CIGNA decided on August 20, 2009 that she no longer was totally disabled. Additionally, CIGNA further advised on August 25, 2009 that under the terms of the group life insurance, Ms. Magee’s waiver of the premium for her life insurance benefits was being denied because they found her not to be totally disabled from performing “any occupation.”

After 7 months of receiving no disability benefits, the administrative appeals on her long-term disability benefits were successful and CIGNA / LINA again awarded Ms. Magee her LTD benefits. However, in a separate letter on April 8, 2010, CIGNA / LINA advised that Ms. Magee’s claim for the waiver of the premiums on her group life insurance policy would continue to be denied because she did not meet the definition of disability of “any occupation.” Ironically, 5 days later CIGNA / LINA sent a letter advising Ms. Magee that the definition of disability for her long-term disability benefits was changing on July 27, 2010, but that she would continue to meet the definition of disability under the “any occupation” definition.

After providing additional medical records and exhausting her administrative appeals with CIGNA / LINA, Ms. Magee was forced to file a lawsuit to enforce her rights under the plan to receive the waiver of her premiums of the group life insurance benefits.

With the lawsuit, Ms. Magee is seeking a declaratory judgment declaring that she is entitled to the waiver of the premiums on the group life insurance policy and an order compelling CIGNA LINA to provide the waiver. Additionally, Ms. Magee seeks attorney fees and costs. Our law firm handles similar cases, however this lawsuit was not filed by Attorneys Dell & Schaefer. As nationwide disability lawyers we are obligated to constantly monitor the numerous lawsuits that are filed on a weekly basis against insurance companies.



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