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