Cigna Overturns Denial of Long Term Disability Benefits

Our client, a former inventory control specialist for Johns Hopkins University, suffered a devastating stroke that ultimately left her wheelchair bound and with significant vision problems. Following the stroke she submitted a claim for disability insurance benefits through Johns Hopkins group employee disability plan with Cigna. Her initial experience with Cigna was not necessarily problematic as Cigna approved her short term disability claim followed by her long term disability claim without much issue. However, the long term disability plan language contained in the Johns Hopkins’ policy only had a 12 month “own occupation” period, which meant that Cigna would only review our client’s claim for disability eligibility as it related to her ability to perform her former occupation for 12 months and thereafter her ability to perform the duties of “any occupation based on her training, education and experience.” In light of this plan language, and despite having received an award of Social Security disability benefits, our client’s trouble with Cigna began soon after her award of LTD benefits.

The First Denial and Appeal.

Approximately seven (7) months into her claim for long term disability benefits Cigna advised our client that based upon a review of her file by medical personnel Cigna had determined that our client would not be disabled beyond the initial twelve (12) month period. At that time Cigna sent our client a check for the remaining five (5) months of “own occupation” benefits. To most people it would seem absurd that Cigna would be able to determine our client’s ability for work five months into the future while simultaneously ignoring the opinions of her treating physicians and the Social Security Administration as it relates to her entitlement to continued disability, but to Cigna it was just another claim denial.

In light of her medical condition and the information strongly in support of her continued right to benefits our client, with the assistance of her family, filed her appeal of Cigna’s denial of benefits. Although she provided additional medical evidence in support of her disability, after conducting yet another medical file review Cigna advised our client that it was upholding its denial of her claim for continued benefits.

The Second Appeal.

Following the denial of her appeal our client was referred by her Social Security disability attorney to Attorney Stephen Jessup to assist her in her fight against Cigna. Cigna is one of the few disability insurance carriers that provide a voluntary second level of appeal. Upon review of the information Attorney Jessup determined that it would be prudent to file the voluntary appeal on our clients behalf. However, the voluntary appeal comes with a very significant caveat- due to the fact that ERISA only requires one mandatory level of appeal that requires Cigna to have a file reviewed by personnel who had no hand in the claim denial, for purposes of a voluntary appeal Cigna is not required to have the second appeal reviewed by a fresh set of eyes who had no part in previous reviews. As such, Attorney Jessup knew that he would have to convince a Cigna doctor who had already determined that our client was fit for work that is opinion was wrong.

In all of the reviews conducted by Cigna, Attorney Jessup knew that the one piece of information that could be crucial in establishing that our client did not have the ability to work at a sedentary demand occupation as Cigna believed would be a functional capacity examination. Normally, when an FCE is performed a period of time after the denial of benefits an insurance carrier will typically argue that the results of the testing are not contemporaneous to the time of the denial and are therefore not an accurate reflection of physical ability. However, since Cigna denied our client well in advance of the change in definition of disability, and the fact that the denial of her first appeal came at the time of the end of the initial twelve (12) month benefit period, Attorney Jessup knew that the chances of Cigna outright ignoring the testing would be minimized.

Given our client’s physical state the FCE came back that she was unequivocally unable to perform any work on full time basis. Armed with the test results Attorney Jessup sent medical condition specific questionnaires to our client’s treating physicians that not only addressed the FCE findings, but also specifically targeted the medical reviews performed by Cigna. Attorney Jessup also made extensive argument against the vocational review performed by Cigna to systematically prove our client would not be able to perform the alternate occupations noted by Cigna’s vocational department.

The Approval.

After all the information necessary to file our client’s voluntary appeal had been compiled, Attorney Jessup submitted a thirty-four (34) page administrative appeal with one hundred and thirty (130) pages of additional medical information. Despite the overwhelming amount of evidence in support of disability, Cigna continued to find any way to deny the claim to include delaying the decision by taking their 45 day extension in order to perform additional medical reviews. Ultimately, Cigna was left with little choice and notified our office that it was reinstating our client’s claim for long term disability benefits.

Attorney Jessup continues to represent our client to ensure that Cigna does not try to terminate her claim again. If you have a disability insurance claim that has been denied or is under review and have questions regarding your claim, please feel free to contact our office to speak with one of our disability insurance attorneys.

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FAQ

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.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

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