CIGNA Reinstates Benefits for Freight Company Truck Driver Following Successful Second Level Appeal

Our client, Mr. W, formerly worked as a freight truck driver for a shipping company. In January 2015 a number of medical issues, including Diabetes as well as lung and kidney problems, forced Mr. W to stop working and submit his claim for disability benefits, first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by CIGNA.

Although Mr. W’s occupation as a truck driver was quite physically demanding, he would be considered totally disabled under his employer’s disability policy if he was unable to perform the material and substantial duties of “any occupation” for which he was reasonably qualified, which is a much more lenient standard for the insurance carrier to meet.

After paying Mr. W for the maximum benefit period under the STD policy, CIGNA approved his LTD benefits for just 2 months then denied his claim on the basis that he allegedly no longer met the policy definition of disability. Specifically, CIGNA determined that “it did not appear that his symptoms were at a level of severity that would necessitate an ongoing preclusion from work.” Mr. W appealed the decision and his claim was again denied. On appeal CIGNA determined that his supported restrictions and limitations would not preclude him from performing sedentary occupations. CIGNA also conducted a vocational review and identified three gainful occupations Mr. W could allegedly perform. Following the denial, Mr. W was offered a voluntary second level of appeal.

After receiving the second denial, Mr. W contacted Dell & Schaefer and discussed his case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in CIGNA’s previous denial letters and in the physician consultant’s medical reviews, and agreed to prepare and submit Mr. W’s voluntary ERISA appeal with the assistance of his appeal team.

The appeal addressed all of CIGNA’s short-comings and reasons for denial, with a special focus on the review conducted by CIGNA’s in-house nurse consultant and medical peer review physicians. One of the focal issues was the potentially prejudicial information CIGNA’s claims personnel shared with the medical reviewers and the reviewers offering claims opinions outside the scope of their expertise.

Approximately ninety days later, and after reviewing the appeal and hundreds of pages of exhibits and medical records, CIGNA overturned its decision to terminate the claim and reinstated Mr. W’s long-term disability benefits.

If you need assistance on a similar matter, please to contact us 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.

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Prior to hiring Dell & Schaefer I was represented by a different law firm that was handling my disability claim. An alleged problem with my disability claim arose and my lawyer at the time scared me so much. A close friend recommended that I immediately speak with Dell & Schaefer, which I did. They were amazing in their approach, explained how there was no problem at all with my situation and took care of it within a week. They have been my attorney now for the past 7 years and have handled any situations or questions so professionally and quickly.

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