Cigna Denial of LTD Benefits for Schlumberger Shop Manager Upheld

In Jerry Courville v. Life Insurance Co of North America (LINA), Plaintiff was employed as a shop manager for Schlumberger Technology Corporation (STC). In 2015, he began experiencing neck and back pain. In July 2015, he underwent a three-level spinal fusion. Three months later, he underwent a one-level spinal fusion.

Plaintiff filed a claim for short-term disability (STD) benefits through his employer’s Schlumberger Group Welfare Benefits Plan (Plan) which included a disability benefits component. The Plan was funded by STC, which contracted with his employer. The Plan was administered by LINA, also known as Cigna Life Insurance Company of New York (Cigna).

neck pain cigna disability denial
Neck pain disability benefits denial by CIGNA

Plaintiff’s claim for disability insurance benefits was approved beginning on July 20, 2016 based on his inability to perform the job duties of his own occupation. After 26 weeks, when he had exhausted his benefits, his claim for long term disability (LTD) was approved with benefits beginning on January 18, 2017. At that time, Cigna informed Plaintiff that it would continue to monitor his eligibility for benefits and would periodically request updated information to confirm he met the requirements for receiving benefits under the Plan.

On August 11, 2017, Cigna advised Plaintiff the definition of disability would change on January 17, 2018, at which time he would need to prove he was “unable to perform the duties of any occupation…for which you are reasonably suited due to your education, training or experience.” On that January date, he would have received 78 weeks of disability benefits.

On August 15, 2017, Cigna requested copies of Plaintiff’s updated medical records and other information from his treating physician that would support his claim for continuing LTD benefits. Subsequently, on various dates the treating physician sent information to Cigna. The last communication was sent to Cigna on November 15, 2017 and was based on the last examination of Plaintiff dated July 27, 2017.

Cigna had the records reviewed by a board-certified orthopedic surgeon who concluded that the restrictions placed on Plaintiff by his treating physician were not supported by the record. Additionally, Cigna performed a transferable skills analysis (TSA) and identified at least two occupations that Plaintiff could perform in addition to his ability to perform the duties of his own job.

On November 16, 2017, Cigna informed Plaintiff that it was unable to continue paying benefits beyond November 17, 2017. Cigna explained that his medical records and all other information it had reviewed, “did not show Plaintiff was functionally limited to the extent that he could not perform the normal duties of his job.”

On February 5, 2018, Cigna received a letter from an attorney requesting Plaintiff’s file, but the letter did not include a signed release from Plaintiff authorizing the release of his medical records to the attorney. It was not until May 15, 2018 that Plaintiff finally submitted his authorization to release his files to his attorney. Plaintiff then filed a request for an administrative appeal.

On appeal, Cigna had Plaintiff’s medical records reviewed by three doctors: one board-certified neurologist, one board-certified orthopedist, and one board-certified psychiatrist. All reviewed the medical file. The board-certified orthopedist tried to contact Plaintiff’s treating physician, but the treating physician did not respond.

On June 14, 2018, Cigna notified Plaintiff’s counsel that the appeal was denied and Cigna would not pay benefits past November 17, 2017 on the grounds that “the records submitted did not support functional deficits that would prevent Plaintiff from performing the normal duties of his job.” Plaintiff then filed this ERISA lawsuit, claiming Cigna’s denial of further LTD benefits was arbitrary and capricious.

Cigna’s Decision to Deny LTD Benefits was Supported by Substantial Evidence and Therefore not Arbitrary and Capricious

Plaintiff claimed that Cigna abused its discretion in denying him LTD benefits when his treating physician declared him to be disabled and instead relied on the opinions of reviewing physicians.

The Court relied on Fifth Circuit precedent and determined that “ERISA does not require that plan administrators “accord special deference to the opinions of treating physicians…or impose a heightened burden of explanation on administrators when they reject a treating physician’s opinion.”

After reviewing the entire administrative file, the Court found that “substantial evidence supports [Cigna’s] decision. The Court noted that the insurance company considered “not only the form submitted by [the treating physician] but also the various test results and medical evidence submitted.”

The Court continued that “numerous courts have held that there is no abuse of discretion when there is evidence in the record to support a claim of disability, when there is also evidence supporting a denial of benefits.” The Court then held that there was substantial evidence to support the denial of benefits and that the denial of benefits was not arbitrary and capricious.

ERISA Preempts Louisiana Law

Plaintiff also claimed that the definition of disability contained in the policy was over broad in violation of a specific Louisiana Statute. The Court noted that:

  1. ERISA preempts state laws.
  2. Even if not preempted, the Plaintiff did not make it clear what action the Court should take for such a violation.
  3. Even if not preempted, the Plan was self-funded and therefore it would not be regulated by the Louisiana Insurance Code.

For these reasons, Plaintiff’s claim under Louisiana law was denied.

This case was not handled by our office, but if you have any questions about your disability claim, either for STD benefits or LTD benefits, do not hesitate to contact one of our attorneys at Attorneys Dell & Schaefer for a free consultation.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

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.

Reviews   *****

Renee G.

My experience was good. The staff was dedicated to the client. Attorney Palamara made sure all my questions and concerns were answered.

Read 424 reviews

Speak With An Attorney Now

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