Cigna overturns Short Term Disability Denial and awards Long Term Disability Benefits
Author: Attorney Alex Palamara
A former employee of Critigen, Inc. contacted our office after the Life Insurance Company of North America (aka Cigna) denied her claim for Short Term Disability (STD) Benefits. This Client Services Manager had previously worked at Critigen since 2011 but found herself unable to continue to perform the material duties of her regular occupation due to serious neck issues. In fact, she had 3 prior surgeries that were unsuccessful. In addition to the chronic neck pain, the Client Services Manager also suffered from: Cervical Post Laminectomy Syndrome, Chronic Cervical Radiculopathy, Cervical Disc Displacement, Cervical Degenerative Disc Disease, Bilateral Upper Extremity Pain, Numbness and Tingling in the Bilateral Upper Extremities, Bilateral Shoulder Pain, Bilateral Knee Pain, Bilateral Knee Osteoarthritis, Bilateral Feet Numbness and Tingling, Sjogren’s Syndrome, Rheumatoid Arthritis, Chronic Pain Syndrome, Headaches, Right Occipital Neuritis, Vertigo, Gastroesophageal Reflux Disease, Osteopenia, Fatigue, Arthralgias, Fibromyositis/Myositis, Paraesthesia, Mild Chest Pain, Chronic Obstructive Pulmonary Disease, Asthma, Shortness of Breath, Reactive Airways Disease, Chronic Cough, Impaired Sleep, Blurred Vision, Lacrimal Disorder, Sleep Apnea and Anxiety.
As one can imagine, with such a list of injuries and sicknesses, there was no way that our now client could continue working despite her desire and efforts. Because she could not continue to work, she made a claim for Short Term Disability benefits through a policy her employer provided through Cigna. This policy, and the accompanying Long Term Disability (LTD) Insurance Policy, was in place for this very reason: to provide income if she is “unable to perform the material duties of… her regular occupation.”
After stopping work in May of 2014 and applying for STD benefits, benefits were in fact approved and paid for a short time period. Unfortunately, benefits were only paid through July 14, 2014 and by way of a denial letter dated July 29, 2014 Cigna informed her that benefits were terminated because “the medical information on file does not document ongoing severity of your condition that would preclude you from your occupation beyond July 14, 2014.”
Realizing that she could not return to work and that she was unable to perform her own regular occupation or even any occupation, this Colorado Client Services Manager found disability Attorney Alexander Palamara of Dell & Schaefer.
Alexander Palamara of Dell & Schaefer Gets Involved
Within hours of being contacted, Attorney Palamara reviewed the denial letter and relevant medical records provided. From this review it was crystal clear that not only was Cigna’s decision blatantly wrong, but there was no way that the Colorado Client Services Manager could return to work in the foreseeable future, if ever.
Review of the Claim File
After reviewing all of the medical records from our now client’s treating physicians and after reviewing the entire claim file from Cigna, it was apparent that the reviews relied upon by Cigna, reviews that were conducted by its own employees, were so biased that they possessed zero reliability. An administrative appeal challenging Cigna’s findings and ultimate determination was quickly filed. This appeal not only demanded overturning of the STD denial but commanded that LTD benefits be approved. The appeal challenged Cigna’s internal reviews and pointed out the overwhelming objective evidence found in our client’s medical records that easily demonstrated her satisfaction of what it means to be disabled under the policies.
Cigna Overturns Its Incorrect Decision and Awards STD and LTD Benefits
Within a month of the appeal being filed, Cigna contacted our office and informed us that the denial of STD benefits was being overturned. Shortly thereafter, LTD benefits were also approved. Our client has now received all STD benefits owed and is now receiving LTD benefits monthly.
Our client is pleased that Cigna is now paying benefits rightfully owed. She knows that with the help of Attorney Palamara and Dell & Schaefer, she will continue to receive benefits as they will do whatever it takes to see that she remains on claim until she is able and ready to return to work.
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.
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