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.

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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
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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.

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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.

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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   *****

Cynthia B.

I learned in March 2014, that my LTD insurance provider was auditing my case. Two weeks later I received a denial letter. I didn’t even have time to provide the info requests to my doctors much less have them completed and sent back to the LTD company. I promptly called the rep who fumbled about for a few minutes then stated that the letter was mistakenly sent to me. The rep (I’ll refer to him as L) was often rude and aggressive even bordering on threatening on the phone.

They did not contact me from early June, I think, until September when L called me to inform me that my payments had already been stopped and a denial letter was in route. This letter informed me I had not complied in getting information from my Doctors and, he claimed in part that since they were not responsive to the insurance company, I was now in receipt of this denial letter. After all he claimed, I really was just fine (not quoted but implied in my opinion). I had not heard a word from L in 3 months prior to that call. I had been promised I no longer had to talk to L after I complained to the insurance company. How surprised I was to pick up a call from L. He seemed quite pleased to let me know they had already stopped my payments. Long story short, like you perhaps, I was scared and had no idea where to turn. Did I need to find a local attorney? That’s what I started doing. I quickly learned there were a lot of people who had or were currently going through the same thing. Misery really does seem to love company.

I started reading other people’s stories and often ran into the Dell & Schaefer name. I was skeptical. I mean, who chooses an attorney over the internet? I learned there were topics this law firm had placed on You Tube? I intently read everyone of them. I admittedly was impressed as they carefully described the process and what to expect. I read more than once. I called the national number listed. I made my choice when I spoke with Alexander Palamara, Esc. He was very informative, confident and encouraging. All of which I was not feeling prior to that call. I made my decision and never looked back. I knew without question that I would never be able to win this case on my own. I was so naive that I didn’t understand that what I thought was a very reputable and certainly well known Insurance company, would blatantly lie. They did. My attorney learned during the discovery process that they had, had much of the information they said they never got. They had had it for months. I never had to wait for response from Alexander, my attorney. If he was not available, his assistant would contact me. I was always in the loop and well informed. I was still shocked at the glaring discrepancies noted in my filing as opposed to what was noted by the insurance company’s denial letter. Some say, “Trust but verify”. I would Strongly recommend, “Don’t trust And Verify!” Act as early as you are able. Expect to provide your doctors names, addresses and phone numbers and dates. Then expect to be well represented. It’s well worth your time and money to pursue your case with Dell & Schaefer.

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