Cigna Overturns Decision to Deny Short Term Disability Benefits to Independent Living Coordinator Suffering from Chronic Pain, Lupus, Fibromyalgia and Connective Tissue Disorder

Prior to contacting Dell & Schaefer our client had already endured a long, frustrating battle with Cigna. At the age of 63 she had expected that her career as an Executive Director for Independent Living Facilities would end as she neared Social Security Retirement Age. However, her health had another plan for her. For some time she had heroically continued to try to work despite suffering from a multitude of medical conditions, including: Lupus, Fibromyalgia, Connective Tissue Disorder and Rheumatoid Arthritis. Despite her best efforts the demands of her job and her responsibility for the overseeing of multiple facilities began to take a toll on her body. As her pain and symptoms increased she had no choice but to turn to the short term disability policy that her employer had provided. Like many people who file a claim for disability benefits under their employer’s Group Disability Policy, she had no idea how hard a fight it would be.

The First Cigna Denial Of Short Term Disability Benefits

In November 2011, she filed her application for short term disability benefits with Cigna. By January 11, 2012, she received notice that her claim was being denied due to what Cigna claimed to be a lack of medical information provided that demonstrated an inability to perform the duties of her regular occupation. This, despite the fact her doctor had consistently and staunchly voiced his opinion that she was not able to perform the duties required of her occupation. What made this an even tougher pill to swallow is the fact that Cigna ignored her doctor’s medical opinion in favor of the opinion expressed by its in-house nurse.

On her own, our client filed an appeal of this decision. Submitted with the appeal was another lengthy statement drafted by her doctor that once again detailed her multiple medical conditions and expressed his opinion that based on her medical conditions she would not be able to perform the duties of her occupation. Cigna this time decided to not cut corners and rely solely on the opinion of its nurse case manager, and instead used an internal medical director to review her claim. It was with little surprise that based on the medical director’s review Cigna, in April 2012, advised our client they were upholding the denial of her appeal, stating that the “[I]nformation provided did not support severity of condition to support functional impairment.”

The Second Appeal of A Cigna Short Term Disability Denial

Disheartened and tired from fighting with Cigna, our client contacted Attorneys Dell & Schaefer to handle the filing of her second (and final) appeal. Attorney Stephen Jessup was assigned to her case and worked with her to prepare this incredibly important final appeal. This appeal represented the last opportunity she would have to provide information sufficient to establish in Cigna’s mind that she would not be able to perform the duties of her occupation. Attorney Jessup started the process by obtaining a copy of the claim file and conducting a thorough review of same. It was quickly realized that Cigna did not even have a copy of her job description on file, nor had Cigna conducted any type of vocational review to better understand what our client’s occupation entailed. Obviously, this begged the question of how could Cigna assert she was not prevented from performing her occupation when they didn’t have any idea what her occupation actually entailed? Furthermore, it was discovered that Cigna did not have many of our client’s medical records; records that helped provide a complete picture of our client’s medical conditions and their impact on her ability to work.

Attorney Jessup coordinated testing for our client to undergo, which helped provide quantifiable information to substantiate physical restrictions and limitations. Additionally, he reached out again to her long time treating physician to prepare a statement that was specifically crafted to undermine the opinions of Cigna’s medical reviewers. Armed with additional proof of disability, Attorney Jessup submitted our client’s final appeal for short term disability benefits and requested a contemporaneous review of her claim for long term disability benefits.

The Decision to Reverse the Cigna Denial

Based on the overwhelming body of medical information and unable to hide behind insufficient and incomplete reviews of our client’s file, Cigna reinstated her claim for disability benefits through the entire period of short term disability. Currently, Cigna is conducting its review of her entitlement to Long Term Disability benefits.

Every day people file for short or long term disability benefits through policies provided by their employers. For those whose claims are denied very little information is provided to explain the importance of the Appeal process and the ramifications if one fails to adequately prepare same. Failure to provide information necessary to establish entitlement to disability benefits in an Appeal could result in a claimant from being barred from ever providing same. It is imperative that before you file an ERISA appeal of a disability claim denial that you speak with an attorney so you can understand your rights. Please feel free to contact Attorneys Dell & Schaefer via phone or through our online contact form for a free consultation.

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FAQ

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
  • 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.

How can I contact you?

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   *****

Monica H. (Pennsylvania)

My experience with this law firm was amazing. The turnaround on my case was unbelievable in a great way. It was business being handled however my team made me feel like a family member as well. The law firm is very professional, and attentive to your needs. If you’re seeking great representation, I recommend Dell & Schaefer to handle your needs. I would like to thank my attorney Rachel Alters and paralegal Sonia for the amazing job working on my case.

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