CIGNA ordered to pay disability benefits to hr administrator diagnosed fibromyalgia

Mrs. Rebecca Duperry worked as payroll benefits HR administrator for Railroad Friction Products Corporation (RFPC) until April 7, 2006.  Mrs. Duperry suffered from rheumatism, and stopped working in April pursuant to the advice of her rheumatologist.  The rheumatologist told Duperry to ‘low her work down’ and that cutting hours was a good idea, although working from home would be an even better idea.

October 16, 2006, Duperry claimed disability from three conditions  rheumatoid arthritis, osteoarthritis and fibromyalgia.  Among the documents Mrs. Duperry submitted to CIGNA (Life Insurance Company of North America) were two attending physician statements completed by Duperry’s primary care physicians, Dr. Glenn Harris, and her rheumatologist, Dr. Supen Patel. In his statement, Dr. Harris stated that “plaintiff was limited to zero hours per day of climbing, balancing, stooping, kneeling, crouching, crawling, reaching, walking, sitting, or standing, and that plaintiff would “never” be able to return to work.” A statement was made also by Dr. Patel that Duperry was ‘permanently disabled’ and therefore could not return to work.

Because the doctors both filled out additional information regarding what Duperry could perform,  such as sitting, standing, etc., there seemed to be some confusion with their reports. Therefore, Cigna’s case manger Melissa Graham, sought input from a nurse case manager.  Cigna’s nurse case manager contacted Dr. Patel who explained that Duperry was disabled from fibromyalgia, rheumatoid arthritis and that she suffered from achiness and other symptoms.  He stated that her rheumatoid arthritis was under control at that point, but that she was still unable to return to work.

Based upon a brief conversation with Duperry’s treating physician, Cigna concluded that Duperry did not have sufficient evidence to prove she was disabled. Duperry appealed the denial, and Cigna hired Dr. Levesque from Duke University Medical Center, to conduct a paper review of Duperry’s medical records.  Dr. Levesque opined that Duperry is not disabled as the “the restrictions by Dr. Patel and Dr. Harris are not supported by the available information.” Duperry’s initial application for long term disability benefits was denied an her appeal was denied by Cigna on February 15, 2008.

On April 18, 2008 Duperry submitted a second appeal to Cigna, highlighting her recent approval of Social Security Disability benefits. On April 23, 2008, Cigna stated that they would not allow a second appeal as she had exhausted her appeals. Cigna could have easily avoided a lawsuit had they simply considered Duperry’s updated medical information.

Duperry then proceeded to take her case to court, in which Cigna continued to argue that Duperry’s disability was based upon subjective pain complaints and lacked objective evidence.  In every report from Dr. Levesque, the medical conditions of Duperry were acknowledged, however the Dr. found none of the conditions to be disabling. Duperry claimed disability as a result of her chronic pain.  During the courts review of the case, the judge stated, “There is no limitation that a disease cannot be disabling on the basis of pain or other self-reported, subjective symptoms alone.”

The court looked at Cigna’s basis for denial, Dr. Levesque’s statements, including the “lack of physical findings associated with this diagnosis.” The court maintains that a disability can exist although there is no objective evidence of a disability.  The pain alone can be enough for an individual to be considered disabled and with her Fibromyalgia, Duperry was.

The court reversed Cigna’s denial of long-term disability benefits and ordered Cigna to pay her disability benefits and all related court costs.

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