CIGNA overturned previous denial of waiver of life insurance premiums

Our client was the husband and beneficiary of Ms. S, who formerly worked as a registered nurse for a regional Healthcare System. In January 2016 a number of medical issues, including cerebrovascular constriction syndrome, vasomotor headaches, unspecified neurocognitive disorder, chronic fatigue, and chronic pain syndrome forced Ms. S to stop working and submit her claim for disability benefits under her employer’s long-term disability (LTD) policy, which was funded and administered by CIGNA. Her claim was approved and paid until her death. At the same time Ms. S applied and was approved for the Life Waiver of Premium benefit which allowed her to maintain the life insurance coverage and waived the payment of premium for as long as she remained totally disabled. Under the policy’s LWOP provision, she would be considered totally disabled if, for the first 9 months, she was unable to perform the material and substantial duties of her regular occupation. Thereafter she would be disabled is she was unable to perform all of the material duties of any occupation she was qualified to perform.

After approving Ms. S’s claim for the first 9 months, CIGNA denied continued LWOP coverage alleging “Ms. S is transferable to other occupations and no longer meets her Policy’s definition of disability.” Unfortunately, in October 2017 while her initial LWOP appeal was pending Ms. S passed away. The appeal was approved for a closed period ending in May 2017 she was denied coverage at the time of her death in October 2017. After receiving the denial, Ms. S’s husband contacted Dell & Schaefer and discussed her 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 Ms. S’s ERISA appeal with the assistance of his appeal team.

The LWOP 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 and significant inconsistencies with its medical reviewer’s findings. In particular, the appeal addressed the fact that, CIGNA’s medical reviewer (a) confirmed Ms. S had co-limiting psychiatric conditions complicated by severe fatigue; (b) agreed with Ms. S’s treatment providers opinions and acknowledged that they were well supported by medically acceptable clinical diagnostic techniques; and, most importantly (c) she was limited to just 4 hours per day, 3 days per week of functional activity. Accordingly, there was no reasonable basis on which to claim that Ms. S was capable of any occupation requiring full time or part time sedentary work with reasonable continuity on a regular and sustainable basis. In addition, the appeal relied on the opinion of an expert vocational consultant who concluded the Transferable Skills/Occupational Analysis completed by CIGNA was not valid or reliable because it lacked any supporting evidence that there is a labor market for individuals limited to working no more than 3 days per week for 9-12 hours maximum.

Less than six weeks later, and after reviewing both appeals and hundreds of pages of exhibits and medical records, CIGNA overturned its decision to terminate the LWOP benefit and reinstated Ms. S’s life insurance coverage. Two weeks after the overturn, CIGNA paid out the full life insurance benefit to Ms. S’s husband/beneficiary. Feel free to call our disability attorneys for a free consultation regarding any matter relevant to your disability claim.

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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.

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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   *****

Daniel

We all make, everyone of us, life altering decisions everyday that could and often do, save or change the course of our lives. Something as simple as driving to the market one rainy afternoon for groceries with the children carefully strapped and tucked into their car seats… safety belts secured around each one them and returning them home safely… intact – also very important… choosing the right early education program for one of those youngsters who is struggling to “keep up” in school – or maybe it’s a quality of life choice so very important to you personally like… choosing the surgeon who will repair a delicate to treat and painful spinal disc ailment that has caused you years of terrible suffering.

We regularly make decisions that affect our personal and family lives within the context of the times we are living in when we make them. We place our faith and trust in the professionals we select to advise us on these and other very important matters. These “coaches”, as I will continue to refer to them, are Physicians, Lawyers, CPA’s, Financial Investment Consultants, RealEstate Professionals, Insurance Experts, etcetera. These carefully chosen advisers keep us abreast of new opportunities for healing, financial growth and security while at the same time appraising us of the risks and dangers that occur minute to minute both over and under the world’s constantly changing landscape. When the unpredicted problem arises and a major problem will happen at least once in all of our lives, we might need to turn to the “law” – the law lives and breathes and changes by virtue of human, political and technical progress. Those “Coaches”, I mentioned earlier in this memo, also rely on legal experts to help them and their young as well as you and I who they might advise having been selected by one of “us” as a “coach”. We all in the final analysis, must navigate what is often a cloudy, murky, unsure world as part of survival in and of itself.

My legal “coach”… Cesar Gavidia, who has been helping me find my way in this unsure world, is a lawyer I’m very proud to know. After taking my troubling call about a serious insurance matter, Cesar immediately set about collecting the insurance policy information and after carefully studying the insurance policy language… language with which he was and is very familiar, gave me a “gift” that I cannot repay in kind… the “gift” was faith in the law and more importantly… faith in Cesar Gavidia. If you believe as I do, that a legal “coach” is needed to help flesh out your team of professional advisors… then consider talking to Cesar.

We live in a cynical world and we are all afraid of the “unknown”. Step into the knowledgable, kind, generous, professional world of “law” as practiced by Cesar… he really, really, really saved me. And although there are no absolutes… my insurance problems may need more care… a constant I can rely on and believe in is Cesar Gavidia. He will protect me by judiciously and honestly applying the “law”. As hard as it is to believe in anything we hear or read today… please believe me… because my still unfolding story just happens to be the unvarnished truth… and Cesar will get me through these insurance issues the right way, by employing the “truth” in the law… I just know he will… i just somehow know he will. Dan

***** 5 stars based on 202 reviews

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