Cigna overturns decision to terminate benefits of Claimant suffering from Multiple Sclerosis

Cigna terminated long-term disability benefits as it determined that the claimant was no longer unable to perform the material and substantial duties of any gainful occupation. However, the medical and occupational documentation clearly established that due to physical and cognitive limitations stemming from her diagnosis of Multiple Sclerosis (MS), the claimant was unable to perform the material duties of her regular occupation as a Technical Writer or any occupation for which she is or may reasonably become qualified based on education, training or experience. The claimant is a 45 year old female who was forced to go out of work on disability on August 8, 2015 due to increasing difficulty with chronic relapsing MS in spite of multiple treatment efforts. Her symptomatology include but is not limited to multiple episodes of optic neuritis, vertigo, frequent urinary tract infections, muscle/back aches, neuropathy, and difficulty with balance. In addition, she also suffers from profound fatigue and cognitive difficulties which have progressively worsened.

Cigna Approves Benefits under the “Own Occupation“ Definition

Prior to going out on disability, she was employed as a Technical Writer for BSH Home Appliances Corporation. According to her job description, she worked under the engineering department and was responsible for providing the documentation necessary to allow efficient and effective servicing of products when service is required. Although the exertional demand of the occupation was deemed to be sedentary in nature, the job description reflects that local travel was material to the role. In addition, a high degree of focus, concentration, and attention to detail is material to performing her occupation successfully. She applied for long term disability insurance benefits under her policy with Cigna as her condition had progressed to the point where she was no longer physically or cognitively able to perform her occupational duties effectively. Upon review of the medical records, Cigna agreed that her condition was of such severity that it would in fact prevent her from performing the material duties of her occupation as a Technical Writer; therefore, in a letter dated May 16, 2016, Cigna approved her claim for Long Term Disability benefits as of her effective date of disability of August 8, 2015.

Cigna Determines Claimant is Not Able to Perform Duties of Any Occupation

Approximately a year later on May 25, 2016, Cigna found that the severity of her condition would not only render her disabled from her own occupation, but also from any occupation for which she may reasonably become qualified based on education, training, or experience. Hence, Cigna continued her LTD benefits and also approved her for Waiver of Life Insurance Premiums benefits which she would only be eligible for if totally disabled and unable to engage in any occupation.

Out of the Blue, Cigna Terminates LTD Benefits Claiming She Can Now Return to Work Full Time

The claimant experienced no significant improvement in her condition and given the progressive nature of her diagnosis improvement was highly unlikely. Although she may have experienced some good days, characteristic of the remitting/relapsing nature of her Multiple Sclerosis, the ongoing frequency, intensity, and duration of her symptomatology would never allow for sustained work activities 8 hours a day, 40 hours a week – even at a sedentary level. It is unconscionable that Cigna would terminate both her LTD and waiver of premium benefits, approximately a year after deeming her totally disabled and unable to engage in any occupation, on the “purported” basis that she was “now” capable of performing the material duties of her occupation. Cigna’s decision suggests that she miraculously recovered from her diagnosis of MS which was not only unfounded but illogical in light of the medical evidence and the very nature of her medical diagnosis. Of significant concern, Cigna did not as much as request a neuropsychological evaluation to assess her cognitive ability, although such examinations are provisioned for in the Policy and given Cigna itself noted in April of 2016 “Employee with her major multiple sclerosis complaints continued to be memory loss and cognitive decline…” Clearly, Cigna’s decision was arbitrary and capricious, demonstrating an abuse of any purported discretion they may have under the policy.

Furthermore, the claimant’s treating physician confirmed based on the medical evidence to include her diagnostic and laboratory findings that there was evidence of progression of her Multiple Sclerosis, and her diagnosis was upgraded from remitting/relapsing MS to Secondary Progressive MS (SPMS). Clearly, Cigna failed to meet its burden of proving that the claimant was no longer disabled under the terms of her policy. Cigna ignored the clinical evidence to the contrary to include its own prior reasoned assessment and determination supporting disability. Cigna provided absolutely no explanation for its change in opinion after deeming her disabled and unable to engage in any occupation in May of 2016, less than a year prior to its adverse decision.

After a lengthy appeal was submitted by Attorney Alters on behalf of the claimant, Cigna overturned it’s determination to terminate her benefits, paid her back benefits and put her back on claim. Attorney Alters will continue to manage her claim to help ensure that Cigna does not cut her off again.

If you have been denied disability benefits by Cigna or any other disability insurance company, please do not hesitate to contact Attorney Rachel Alters at Dell & Schaefer for a free consultation.

Questions About Hiring Us

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

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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, 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   *****

Zane M.

Since day one I continue to have a very positive experience working with the Dell & Schaefer Law Firm. I am especially grateful to attorney Stephen Jessup who was assigned to my case in early 2010. Steven Jessup and Anneli (Registered Paralegal) are always available and very professional in managing my case in a timely manner. Steven explained the entire (LTD) process to me from day one when I became disabled and unable to work due to my disabilities and had my case approved very quick working with my LTD carrier. My health has worsened since then with a life threatening disease and several surgeries / conditions later. He always answers all of my questions in a timely manner and always has a positive outcome for me. I feel highly represented & grateful with Steve as my LTD attorney which enables me to take care of my health to the best of my abilities without worries.

Steve, I sincerely appreciate all you and Dell & Schaefer have accomplished for me from day one in representing me regarding my case in a very quick and timely manner. I would “most definitely recommend” Attorneys Dell & Schaefer to anyone in dire need of the best in legal representation & counseling in short & long term disability cases.”

God bless to you Steven, Anneli, Greg and all of the Dell & Schaefer Law Firm!

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