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 ‘slow 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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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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