CIGNA (LINA) terminates disability payments to woman with multiple sclerosis

Dalit Waissman, a 53 year old who immigrated to the United States from Israel in 1984, came to her position at SAP, Inc. in 1997 with considerable experience in computer programming and educational consultation and resource coaching. She had spent the previous two years working as an independent contractor providing technical writing services.

SAP hired Waissman as one of their Senior Technical writers. The primary duties of her job according to SAP were to provide “excellent research, interviewing and writing skills: information mapping skills; instructional design skills; knowledge of the business cycles; knowledge of computer software, Windows applications and authoring tools; and HTML/Internet knowledge.”

Waissman was also involved in writing documentation that was technically accurate. It also had to follow the company’s writing style. She coordinated and planned information products and new functional descriptions with the integrated solution team. She was involved in development translation and marketing. And she had to ensure quality assurance by critiquing and editing her fellow colleagues work. She coordinated activities with outside vendors and she gathered feedback on products from customers as well as SAP employees. She was involved in managing the documentation library and the intranet delivery mechanisms.

Waissman’s job as a senior technical writer required considerable concentration skills. She worked long hours learning and writing in various programming languages for the different projects. Working under the pressure of deadlines was common. The job was mentally demanding, but it was a sedentary occupation which SAP described as involving about 99% sitting and 1% walking.

Long-term disability benefits are part of employee benefits package.

One of the benefits SAP provided to their employees was a long-term disability income plan and a life insurance plan managed by Life Insurance of America, Inc. (LINA) also known as CIGNA. This long-term disability plan defined total disability as the inability to perform all the essential duties of her job because of injury or sickness. If Waissman was able to earn more than 80% of her indexed prior monthly earnings, she would not be considered totally disabled. Sickness was defined as a physical or mental illness and could include pregnancy. Her life insurance plan waived premiums if she became disabled.

Waissman was diagnosed with interstitial cystitis (IC) in 1987, only three years after her arrival in the United States. IC is an autoimmune disease that causes deterioration of the lining of the bladder. Ulcers form in the lining of the bladder which allow urine to contact underlying tissues and nerves. The condition is extremely painful and requires frequent urination.

Waissman developed other health issues. On September 24, 1999, she underwent surgery for acute appendicitis. After the surgery, she experienced tingling in her feet. Walking was painful. She would experience tingling, prickling and sometimes numbness of the skin covering her legs. She experienced areas of numbness on her abdomen and other neurologic symptoms. She was diagnosed with transverse myelitis and admitted to the hospital on October 13, 1999 for intravenous medication. An MRI indicated that she had an area of demyelination at the T4 – T5 vertebrae in her spine. They also found that her cerebrospinal fluid had positive oligoclonal bands and an elevated IgG index.

Waissman experienced an episode of Bell’s palsy on the left side of her face in March 2000. This caused head pain, vertigo and extreme fatigue.

Symptom diagnosis of MS leads to disability application.

Her treating physician. Dr. Christopher Lock reached the conclusion on May 19, 2000 that Waissman had multiple sclerosis (MS). This diagnosis was confirmed by Dr. Steven Hauser, a neurologist and expert on MS, on July 3, 2000. The last day that Waissman worked for SAP was June 12, 2000. Her annual salary was approximately $109,000.

Waissman submitted her first disability claim to LINA on December 14, 2000. She described her disability in detail. She stated that she was experiencing neurological pain and headaches on a daily/nightly basis. This was accompanied by extreme chronic fatigue. She provided a history of her transverse myelitis and Bell’s palsy, and her subsequent diagnosis of multiple sclerosis after her 5/14/2000 MRI. Dr. Lock completed an attending physician statement, which supported Waissman’s description of her symptoms.

Waissman asked that her medical information be kept confidential because she hoped to return to work. Unfortunately she found that her frequent need to urinate, caused by the IC, became a complicating factor. The IC interrupted her sleep, which only made her more tired.

She sought assistance from Dr. Dennis Facchino, a psychotherapist . When LINA contacted him on February 19, 2001, he reported that she was suffering from “overall depression, fatigue, anxiety and the inability to concentrate . She could not focus on tasks for a significant length of time. The continuous pain, fatigue and inability to concentrate made it apparent that she would not be able to return to work.

She also remained under Dr. Lock’s consistent care. On March 20, 2001, Dr. Lock wrote in his notes that Waissman complained that the burning and pain in her head was often unbearable. She would continue to seek treatment until he left his practice at the Palo Alto Medical Foundation (PAMF) in April 2006.

LINA approves application for long-term disability benefits.

Waissman’s application for long-term disability benefits was approved by LINA on March 22, 2001. Her claim for the waiver of premiums under her group life insurance plan was also approved. The claim file diary noted that performing a TSS would be valueless because Waissman’s problems with MS were cognitive and could not be measured physically. The notes suggested it would be important to learn if cognitive testing had been performed, but the MRI results showing deep white matter and Waissman’s very technical job description made approving long-term disability logical.

Social Security approves long-term disability benefits on first application.

The Social Security Administration approved disability coverage for Waissman on April 24, 2001. SSA re-evaluated her eligibility on April 22, 2005, determining that her disability was a continuing one.

In January 2006, LINA asked Dr. Kenneth B. Graulich to review Waissman’s medical records. While he recognizes that she had been diagnosed with MS, he believed that her headaches might not be connected to the MS. He also recognized that she had IC and depression, but because these were not his area of expertise, he deferred any conclusions as to how these two factors would affect Waissman’s disability to someone who understood these conditions.

LINA seeks independent medical exam to verify disability.

LINA asked Waissman to see Dr. Subroto Kundu for an independent medical examination (IME). She saw him for 30 minutes. He concluded that her MS diagnosis was probable, but stated that MS is a painless disease. He diagnosed Waissman’s fatigue as originating from chronic fatigue syndrome rather than MS. In his opinion, she should be able to perform her regular sedentary occupation because the level of performance her job demanded was similar to that required during her physical examination.

LINA ordered surveillance between April 17 and 19, 2006. Waissman left her property only once – to see Dr. Kundu.

LINA felt that Dr. Graulich and Dr. Kundu’s assessments and the disability surveillance captured while she left her home to see Dr. Kundu justified terminating Waissman’s long-term disability benefits. LINA notified her by letter on May 23, 2006 that her benefits would end on May 25. In the letter, LINA told Waissman that they had shared the IME with her primary care physician, Dr. Susan Elgee and Dr. Lock. Dr. Elgee deferred comment to Waissman’s neurologist. Dr. Lock did not respond either, but he was no longer at PAMF.

Treating neurologist disagrees with LINA’s independent reviews.

Waissman saw Dr. Lock’s replacement, Dr. Gershfield for the first time the same day LINA mailed the benefits termination letter. His findings were consistent with Dr. Lock’s, noting the head pain and fatigue. When she received LINA’s termination letter, she asked Dr. Gershfield to write a letter supporting her continued need for disability benefits. He did so on June 29, 2006.

Dr. Gershfield wrote a second letter in November, after he reviewed her claim denial. He stated emphatically that Waissman’s diagnosis of MS was secure and supported by clinical presentation as well as objective lab and neuroimaging studies. He disagreed with Dr. Kundu’s statement that MS is a painless disease. Dr. Gershfield declared that this statement was false and contradicted the most basic of textbooks in the field. He quoted from the standard textbook on MS, McAlpine’s Multiple Sclerosis, which says on p. 316 that “pain is frequently listed amongst the initial symptoms of multiple sclerosis or as occurring in the course of the disease.”

He expressed great surprise at Dr. Kundu’s diagnosis of chronic fatigue syndrome when discussions of fatigue are common in basic textbooks on the subject. Quoting again from McAlpine, he pointed to the fact that an “excessive sense of fatigue affects the great majority of patients with multiple sclerosis and up to 40% claim this to be the dominant complaint.” He went on to explain that MS fatigue is unlike the tiredness one feels after exerting themselves. It is a fatigue that is constant even when a person is resting. For this reason, fatigue can limit the ability to perform sedentary work.

Disability attorney recommends taking neuropsychological test.

By this time Waissman had hired a disability attorney. At his recommendation, she went to Dr. Sheila Bastien for medical evaluation on January 15, 2007. Dr. Bastien’s neuropsychological report was based on multiple cognitive tests. The results from these tests were submitted to LINA and became part of the administrative record. Here are some of the findings reported:

Test scores verify level of disability.

When Waissman’s test scores were compared to the values defined for a technical writer in the U.S. Labor Department’s Dictionary of Occupational Titles (DOT), it became readily apparent that Waissman would certainly be unable to fulfill the duties of her regular employment.

Dr. Bastien also performed symptom validity tests. Waissman’s scores were normal which Dr. Bastien interpreted as demonstrating that Waissman was not making an obvious attempt to exaggerate or distort her problems.

Will the facts support reinstating long-term disability benefits?

Waissman’s case looks strong at this point. She claims that she has been denied her long-term disability benefits wrongfully. Will the U.S. District Court for the Northern District of California, San Jose Division agree? We will look at the Court’s decision in Did Lina Wrongfully Deny Disability Payments To Claimant With Multiple Sclerosis?

There is one comment so far

  • I know it’s hard to work for so many years almost a lifetime and than hope to retire, but the money she was earning is what we look forward to earn in our lifetime. She must really be sick to not be working especially for the $56.75 an hour she was earning. Some people are on disability, so they made the cut as they say and they now have a life of not worrying about any bills. I am one of those people and I am glad social security was there for me, but once you hit the age of 65 that SSD becomes regular social security.

    Mr. Uriegas Feb 7, 2014  #1

Leave a comment or ask us a question

Questions About Hiring Us

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, 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   *****

Robert M.

At first I wanted a local lawyer that I could talk to in person, however, I could not find one in my own state that would take an ERISA disability case. Once I contacted Dell & Schaefer and talked to my assigned lawyer (Alex) my fears went away. Alex was very attentive to the things that I told him and quickly returned all my e-mails and/or phone calls. He set my mind at ease and worked very hard on my case to ensure a favorable settlement. He provided me with the right advice to settle outside of the courtroom when I was overly aggressive in my approach. He was also able to obtain a favorable settlement for me when I was sure it would not be possible when I started down this path. One of the important factors for my taking this approach was I didn’t have to pay anything to Dell & Schaefer unless they won my case and they allowed me to decide what I was willing to accept in the end.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us