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 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   *****

Mary R.

I first started working with Dell & Schaefer after two failed back surgeries forced me to stop working. I was the major breadwinner of our family and had a very generous compensation package that included long term disability. I was certainly glad to know that I had the long term disability policy to help us during this major change in my family’s life. I was surprised to learn that long term disability means something very different to the insurance company (MetLife) who held my policy. They wanted to place an 18 month restriction on pay out and wash their hands of me. Hardly “long term”.

I hired Dell & Schaefer to fight for me and that they did. They were well schooled in the tactics of insurance companies and they expertly navigated the many barricades the insurance company placed in front of me. They were extremely knowledgeable in all areas of the law and quickly identified a course of action. They were fair and sensitive with my personal concerns and I always felt that I had an advocate on my side. Their experience proved invaluable as they were able to successfully argue my case and win my long term disability case, securing my benefit and my family’s income needs. And they continue to support me, as insurance companies continue to find ways to challenge the validity of your claim even after the initial decision is made in your favor.

Dell & Schaefer handles everything for me. This is an extraordinarily difficult thing I have had to endure. Without this money, I have no idea how my family would have been able to survive. Insurance companies can be brutal on individuals and when one is at their most vulnerable as I was, it is critical to have a knowledgeable and powerful attorney on your side. I like the fact that I don’t have to worry about anything and that everything is handled for me by Dell & Schaefer. I am glad to recommend Dell & Schaefer to anyone who needs a strong advocate on their side.

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