A former Senior Software Engineer for Science Applications International Corporation was forced to leave work on August 28, 2009 due to a multitude of medical issues. These conditions included Depression, Left Ulnar Neuropathy, Low Back Pain with Radiation to the Right Lower Extremity, Type 2 Diabetes Mellitus, and Lumbar Disc Disease. Soon thereafter he applied for and was initially approved by CIGNA for Long Term Disability Benefits with an effective date of February 27, 2010. This claimant received benefits through February 26, 2012 when he was informed on February 24, 2012 that his disability benefits would cease. In the denial letter, CIGNA informed the claimant that because they only found that he was disabled due to depression, his claim would therefore be limited to 24 months as his policy has a 24 month limitation for mental health disabilities. “I have seen hundreds of disability denial letters in which a disability insurance company wrongfully claims a disability condition is mental and not physical,” stated attorney Alex Palamara.
Claimant’s First Administrative ERISA Appeal With CIGNA is Denied
After being denied long term disability benefits the claimant attempted an administrative appeal on his own. Unfortunately this appeal was denied by way of a letter dated June 11, 2012, where CIGNA again ruled that his physical capabilities were not sufficient enough to satisfy that he be “unable to perform all the material duties of any occupation,” the current definition of disability under his policy. In support of this contention, CIGNA now relied upon the findings of an Independent Medical Examination (IME) which found only minimal restrictions based on his physical disabilities. CIGNA used the results of the IME and had a Transferable Skills Analysis completed which found various jobs that the claimant apparently would be able to perform given the restrictions found by the IME doctor.
Claimant Contacts Attorney Dell and Schaefer To Help With Cigna Disability Appeal
Unwilling to give up, the claimant contacted Attorneys Dell & Schaefer for assistance in filing the last administrative appeal. Upon obtaining an overwhelming amount of supportive medical documentation from the client’s treating physicians, Attorney Alexander Palamara was able to show that the client’s physical conditions were more than enough to qualify him as disabled under the policy. Attorney Palamara used CIGNA’s IME results against them to show that it would be unreasonable to expect this client to be able to perform all the material duties of any occupation.
On February 18, 2013, nearly a year to the day after he was first denied, CIGNA informed Attorney Alex Palamara that it had decided to overturn its previous decision and found that the client qualifies for disability benefits beyond the 24 month mental nervous limitation.
If you have a similar situation involving a case against CIGNA or any other disability insurance companies, please do not hesitate to contact us for a free consultation.