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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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There are 6 comments

  • Mike,

    The Waiver of Premium benefit is a separate benefit from your Long Term Disability benefit and is usually reviewed under an “any occupation” definition of disability; whereas your disability benefit is still under the Own Occupation benefit period. The denial of the Waiver of Premium is not a denial of your monthly disability benefit, but it does raise some concerns as to what Cigna may do in the future. Please feel free to contact our office to discuss your claim in detail.

    Stephen JessupOct 9, 2015  #6

  • I need help! Have long term disability and life insurance through Cigna. On 1/3/15 I had a cerebellar stroke. Had short and long term disability through the company I worked for. When the short term expired I was transferred to long term disability. Upon receiving LTD they made me apply for SSD and hired Alsup at their expense to get me SSD. I was awarded SSD in July 2015. Not long after getting SSD I received a letter from Cigna denying me waiver of premium for life insurance saying they don’t think I am disabled and could do other jobs. They have received letters from my doctors stating I am unemployable due to my stroke. I am in the process of getting new doctors statements to appeal but from what I have seen and read will probably not get it done by myself.

    Mike T.Oct 8, 2015  #5

  • Rhonda,

    I am somewhat confused by your fact pattern- did SSDI terminate your benefit or did a private disability insurance carrier?

    Stephen JessupDec 16, 2014  #4

  • I have been on Social Security Disability for 21 years. I got a notice that I no longer was considered disabled, due to information by Doctor. I have seen this doctor twice in the last 2 years, my visits were with the Nurse Practitioner for the last 12 years. He filed out the form from Symetra Life Insurance saying my condition was expected to improve, where did that come from? I also have severe anxiety and panic disorder. I told him last visit I didn’t take the XANAX unless Ii had to go some where, as it makes me so tired. I am on about 6 other medications, very strong. He does not know me, or my situation, the only thing he does is write prescriptions. Is there anything I can do to dispute their decision? I also have severe hearing loss, which I have documentation of by ENT.

    Rhonda GoreDec 15, 2014  #3

  • I,

    Please feel free to contact our office to see how we may be able to assist you.

    Stephen JessupNov 5, 2013  #2

  • I’m having the same problem with Cigna Life Insurance. They have cancelled my waiver of premiums which I’ve had since 1996. I am totally disabled and get LTD benefits through Unum and and through SSD. I live near Tampa Florida and would like to know if you could give me a reference as to who to contact. I have been appealing them since July 2013, when they sent me my first letter. My doctors have sent everything they can send to them and again they denied me. I think this is so unfair as I have so many medical conditions. If you could help me I would greatly appreciate it.

    I. ArroyoNov 4, 2013  #1

FAQ

Do you help Cigna claimants nationwide?

We represent Cigna clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Cigna disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Cigna. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Cigna.

How do you help Cigna claimants?

Our lawyers help individuals that have either purchased a Cigna long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Cigna:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Jim F.

My employer offered both Short Term Disability and Long Term Disability insurance as optional benefits among others. The premiums were significant, but since they could be payroll deducted I felt they could be reasonably managed and the security of continued income in the event of a medical disability was well worth the investment. As with the purchase of a first aid kit, most would prefer never having to use it.

I have been very fortunate to have had few illnesses or injuries throughout my life and more specifically my 45 year career as a healthcare professional. It wasn’t until early in 2012 that I was diagnosed with a chronic, progressive disease of the eye. Symptoms were minimal at that time, though regular visits to a retinal specialist, including regular therapy by ocular injection, were necessary to slow its progression, the symptoms did not appreciably interfere with my work. In spite of my treatments the condition continued to progress. In early 2014 the symptoms began to interfere dramatically with my day to day duties. My job required significant computer use and the reading of copious amounts of medical documentation. It became evident to me that I could no longer meet the expectation of my management and clinical position without working frighteningly long hours and enduring the relentless eye strain and other symptoms related to the illness.

Though I had always planned for eventual retirement from my full-time position, like most professionals I had hoped to be able to continue to practice my profession on a part-time basis throughout my retirement as long as I remained competent and able. That was not to be. Thankfully, I had the foresight to elect the disability benefit options offered by my company and have the premiums payroll deducted for many years. I notified my supervisor and HR representative that I had to stop working due to my condition and proceed with the disability application process.

All went very well and after using up my accrued vacation and sick time, my short-term disability benefits commenced. Since my condition is progressive and incurable I felt secure in knowing that once my short-term benefits were exhausted my benefits would continue under the long-term policy. However, much to my surprise, after receiving about a month of benefits I received notification from the insurance company that a decision had been made to terminate my benefits due to lack of objective medical evidence to support my claim, though significant documentation had been provided by my retinal specialist.

I was bewildered and unsure of how to proceed with an appeal of that decision. Since I had 180 days to do so, I decided to research the matter thoroughly. In spite of my being a veteran healthcare professional everything I had been reading on the subject cautioned about attempting to proceed with an appeal on my own. Legal representation was highly recommended.

I then began a review of local attorneys, hoping to find one that provided enough documentation on their website that indicated experience with non-social security disability related cases. I was also interested in seeing evidence of some experience with disability cases related to diseases of the eye and resultant vision impairment. I was unsuccessful.

So I expanded my search to include national law firms. It was then that I discovered Dell & Schaefer. After thoroughly reviewing their website, watching many of the video discussions, noting experience with vision related cases, particular documentation related to the insurance company that handled and then eventually denied my benefits, and reading a significant number of testimonials, I decided to request a free consultation as advertised. It was one of the best decisions I have ever made.

After that consultation, I was very confident that I was in very skilled hands which alone reduced my anxiety level immensely. Attorney Alexander Palamara and his Legal Assistant, Kathleen Bordes, immediately began managing my case, their professional expertise clearly evident.

They worked closely with my retinal specialist, my optometrist and the insurance company in compiling the medical documentation necessary for a successful appeal in an amazingly short period of time, keeping me fully informed all along the way. Shortly after being notified by the insurance company that my benefits would be reinstated and paid through the full term of my short-term policy I received a lump-sum payment.

Once the short-term disability appeal was successfully completed, Alex and Kathy immediately addressed the long-term policy benefits. Again in a remarkably short period of time I was granted those benefits, receiving a lump-sum payment for benefits to date and will receive a payment monthly going forward per the terms of my LTD policy.

I am extremely pleased with how my case was handled and the very favorable outcome. Alex and Kathy were a delight to work with and extremely professional in every way. Incidentally, the fee I paid to Dell and Schaefer for their incredible representation was very reasonable and very well earned.

I highly recommend the services of Dell & Schaefer to anyone who may find themselves in a similar disability-related situation.

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