Cigna Overturns Denial of Benefits to Data Center Manager

Prior to filing for disability benefits with Cigna our client was the sole Data Center Manager and Software Engineer for an entire city in Florida, and was responsible for making sure all governmental offices’ computer systems were in proper working order. Needless to say his job required a great deal of responsibility, long hours and traveling from government office to office. Like so many people who find themselves on disability, our client’s life changed in a moment’s notice when he was hit from behind in an auto accident.

Following the auto accident he made a claim for short term disability benefits through the city’s group disability policy with Cigna. His initial claim for short term disability benefits was approved and he collected benefits for a short period of time before he attempted to return to work as he loved his job and did not want to be sidelined by the injuries he sustained in the auto accident. However, it was only a matter of time before the long hours and physical demands of his job began to take their toll on his physical well-being.

Return to Disability

Unable to meet the demands of his job in light of his well-documented and objectively verified lumbar and cervical pain and radiculopathy, our client again made a claim for short term disability benefits with Cigna. Unfortunately, this time his experience would be much different than his initial.

Cigna, acting as an administrator for the short term policy, again initially approved our client’s claim for short term disability benefits, but unlike his first claim our client was not going to be able to return to work this time. Like many disability insurance policies, our client’s short term disability benefits were funded by his employer and the long term disability benefits were to be funded by the insurance company. When it became evident to Cigna that our client was going to make a claim for long term disability benefits, which they would be responsible to pay, Cigna terminated our clients claim for the remainder of his short term disability benefits just a few short weeks before his long term disability benefits were to begin.

The termination of his short term disability claim effectively denied his claim for long term disability benefits as receipt of same was contingent on being disabled throughout the entire short term disability period. True to form, shortly thereafter our client was advised his claim for long term disability benefits were denied in light of the short term disability denial.

The Appeal

Following the denial of short term disability benefits, our client consulted with Attorney Stephen Jessup to discuss the denial of his claim and his rights for appeal under his employer’s policies. Attorney Jessup’s review of the claim file revealed that despite being aware of all of our client’s treatment providers Cigna only obtained records from two of his doctors. Additionally, the supposed medical review conducted by a Cigna employed doctor provided a one sentence opinion that the records did not reflect a significant enough impairment to support restrictions and limitations that would prevent our client from working in his occupation. Cigna’s doctor’s opinion was hardly credible in light of multiple MRIs of the Lumbar and Cervical Spine showing positive findings; positive EMG and Nerve Conduction Studies; multiple Injections and a Spinal Cord Stimulator Placement surgery. It was clear to Attorney Jessup that Cigna had hoped our client would give up on his claim and return to work as he had previously done.

Attorney Jessup compiled countless records from our client’s treatment providers that Cigna had failed to obtain, as well as coordinated additional testing to objectively verify physical restrictions and limitations. After all information was compiled and arguments made Attorney Jessup submitted to Cigna an 810 page appeal of the denial of our client’s short and long term disability benefits. Faced with an overwhelming amount of information in support of disability, Cigna notified our office prior to the expiration of the initial 45 day review period that it was overturning its denial of benefits.

Cigna has placed our client back on claim and forwarded all benefits owed. Our client’s claim continues to be monitored by Attorney Jessup to avoid any potential denial of benefits in the future.

Has Your Claim Been Denied?

If your claim for disability insurance benefits has been denied, or you are fearful that your disability carrier is attempting to terminate your benefits please feel free to contact our office to discuss how we may be able to assist you in securing your rightful benefits.

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