Cigna Overturns Denial of LTD Benefits to Computer Systems Engineer after Appeal and Independent Medical Examination

Our client was previously employed as a Computer Systems Engineer. In this occupation, he was responsible for support and maintenance of a real-time system that allows pipeline controllers to monitor pipelines across the United States. Unfortunately for him, he was suffering from Lumbar Discogenic and Facetogenic Pain, Lumbar Radiculopathy, Cervical Spine Pain Status Post Fusion, and Piriformis Syndrome, and required narcotic pain medication. Due to his various conditions, he was unable to continue to work and he therefore filed a claim for LTD benefits under a policy he was covered under by way of his employment. Unfortunately, his claim was denied by Cigna who found that he simply did not meet the definition of disability.

In addition to his physical conditions, the claimant was also suffering from severe cognitive deficits as a result of the narcotic pain medication he needed to control his constant and severe pain. Additionally, he was scheduled for an additional back surgery, and as a result, he was unable to return to any type of full time employment. Although his claim was denied, he knew he couldn’t work and he knew Cigna’s conclusion was wrong. As such, he decided challenge this denial by filing an appeal on his own appeal. The claimant provided Cigna with additional medical records and argued his denial should be overturned because the narcotic pain medication caused cognitive deficits. Unfortunately, his appeal was denied.

In denying the appeal, Cigna once again denied LTD benefits despite a finding by Cigna that he was eligible for Waiver of Premium benefits on a life insurance policy based on the same disability. Neither Cigna nor its claim file reviewers provided a reasonable rationale for its contradictory conclusions regarding the claimant’s disability. Cigna also failed to perform a Functional Capacity Examination (FCE) or Independent Medical Examination (IME) to obtain a true assessment of the claimant’s residual functional capacity, even though the policy governing his claim allowed Cigna to have such an examination conducted.

Upset his appeal was denied and still unable to work, the claimant decided he needed assistance with his claim and found Attorney Alexander Palamara of the Dell & Schaefer law firm.

Appeal by Attorney Palamara:

After reviewing the denial letters, speaking with the claimant, and reviewing the claimant’s appeal, it was clear to Attorney Palamara that Cigna’s denial was improper and that his now client was unable to work. The claim file from Cigna was ordered along with our now clients past and current medical records. Those documents were reviewed to develop a full understanding of his illness, claim, policy, and Cigna’s handling of his claim. After compiling and reviewing all the necessary information, it was clearer than ever that his benefits should be approved.

A detailed review of the claim file revealed Cigna found the claimant disabled under its waiver of premium provision for the Life Insurance Policy, but there was no rationale for its contradictory conclusions regarding his disability under the LTD policy. The review also revealed that Cigna failed to perform a thorough review of Mr. Dehart’s medical records and failed to have a medical doctor of the appropriate specialty perform an examination. Instead, Cigna relied on an inadequate and incomplete paper review and a flawed vocational analysis.

An appeal was drafted and timely filed. The appeal focused on the objective medical evidence in support of his claim, highlighting individual records that contradicted specific allegations by Cigna in its denial. Also included were physician statements that the claimant was limited from prolonged sitting, standing, walking and records showing that his necessary medications affected his cognition, memory and decision making skills. The appeal also highlighted the inconsistencies in the opinion of Cigna finding the claimant disabled and eligible for waiver of premium benefits, but not disabled for LTD benefits, and the failure of Cigna to perform an IME in light of conflicting findings between the claimant’s treatment providers.

Claim Approval:

After filing the appeal and providing Cigna with ongoing, updated medical records, Cigna noticed the claimant for an Independent Medical Examination (“IME”). The IME was coordinated through Attorney Palamara and took place roughly 4 months after Attorney Palamara filed the second appeal on the claimant’s behalf. One month after the IME was completed, Cigna overturned its denial. Our client’s claim was approved and all back benefits that were owed were paid in full. With the assistance and support of his treating providers and their medical records, Attorney Alexander Palamara was able to successfully argue to Cigna that our client was disabled under the terms of the policy.

Our client is relieved to be on claim and to have received all the money that he was owed. Cigna attempted to deny our client’s claim without conducting an IME and properly investigating his claim, but Attorney Alexander Palamara was successful by providing updated medical records and highlighting the legal deficiencies in Cigna’s denial. Attorney Palamara will continue to do whatever it takes to keep the former Computer Systems Engineer on claim until he is able to return to work or until his policy expires.

If you have been denied disability benefits by Cigna or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schafer 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

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, 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   *****

Rhonda L. (Hawaii)

Gregory Dell has saved my family from bankruptcy. I got sick with Vasculitis and had to undergo 4 years of chemo treatments. I worked during this time as pharmaceutical sales rep. Finally my doctors said that if I did not go on to disability I would die. I went on disability and my company rejected my short term disability. I was in the hospital at the time of the rejection and was not given much time to respond. I live in Hawaii and could not find anyone that would go against my company. They were very big and scared all the attorneys off.

Greg took my case immediately. He got me paid and short and long term disability. After a few years Cigna did a ridiculous review of my claim and said that I should be able to go back to work. At the time I was denied I was currently in a wheelchair and on massive doses of morphine. Vasculitis destroyed all my nerves in the legs and arms. They dropped my long term disability. Greg again went back and fought for my disability and won. My family would be completely bankrupt without Gregory Dell. My doctors said with the stress from all this fighting for my rights has cost me years of my life. But I would not have made it without Greg, Michal and team. Money is not everything but when you are sick fighting to pay your bills and insurance companies really takes a toll. I have recommended Greg and his staff to other disabled persons. I think they are the best. Thanks for everything. You have allowed me to focus on what is important staying alive for my family.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us