Life Insurance Company of North America (CIGNA) overturned previous denial of long term disability benefits for New Jersey Account Manager

Our client, Mr. W, formerly worked as an Account Manager for a large entertainment Company. In May 2015 a number of co-morbid physical and psychiatric conditions and ailments forced Mr. W to stop working and submit his claim for disability benefits first under his employer’s short term disability (“STD”) Policy then continuing under his employer’s Long-Term Disability (“LTD”) Policy both benefits were administered and funded by CIGNA. Under both of his employer’s disability policies Mr. W would be considered totally disabled if he was unable to perform the material duties of his regular occupation, which was defined as the occupation he was routinely performing when his disability began.

After paying Mr. W for more than 7 months under the LTD Policy, CIGNA denied further LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, Prudential determined that “the medical records on file do not provide evidence of continuing functional deficits that would prevent you from performing your occupation.” After receiving the denial, Mr. W contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in CIGNA’s denial letter and in the evidence it relied on and agreed to prepare and submit Mr. W’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of CIGNA’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of CIGNA’s denial. The appeal next addressed the fact that the available medical information confirmed that Mr. W suffered severe neurological injuries from a motor-vehicle accident after which he began experiencing extreme balance issues and his thinking became “fuzzy.” Mr. W’s neurological symptoms included serious problems speaking fluently, and he struggled to find correct words. Mr. W was examined by neurologist who conducted a CT scan and concluded that Mr. W suffered severe neurological deficits from the Traumatic Brain Injury (TBI) he suffered in the accident. Along with the cognitive and neurological difficulties Mr. W also suffered from serious orthopedic problems and was unable to walk any meaningful distance, his gait was extremely unsteady, and he required a cane. The appeal also addressed CIGNA’s in-house medical review and established that CIGNA’s reviewer incorrectly and unfairly determined that Mr. W was a malingerer and therefore suffered no restrictions or limitations as a result of his chronic and debilitating illnesses. Yet, the record evidence clearly establishes that each of the statements on which the reviewer based her determination was either pure speculation or contradicted by the available medical information. Accordingly, the reviewer’s opinions were fatally flawed and it was unreasonable for CIGNA to rely on them in support of its denial of LTD benefits.

Five months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records as well as the expert reports, CIGNA overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. W’s LTD claim. Attorney Symonds continues to represent our client to best ensure that CIGNA will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.

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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
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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.

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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.

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Dell & Schaefer Client Reviews   *****

Michael G., DDS, MS

On approaching age sixty-five, there was some question regarding continued benefits for disability resulting from accident as opposed to sickness. My insurers required extensive personal documentation as well as attending physician assessments to justify my claim for benefits beyond age sixty-five, i.e. lifetime benefits. It was then that I sought assistance from a firm specializing in Private Disability Insurance Law.

My search lead me to Dell & Schaefer where I’ve had the pleasure of working with Attorneys Steven and Gregory Dell. Their representation of my interests have resulted in a very smooth and efficient relationship with my insurers.

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