Cigna Reinstates Disability Benefits to Project Manager on Appeal
Author: Attorney Stephen Jessup
Prior to filing for disability insurance benefits our client worked as an executive level Project Manager. She initially went out of work following the removal of a brain tumor, which resulted in complications of bilateral diploma (severe double vision), hearing loss and migraines. Initially, Cigna approved her claim for benefits and issued long term disability benefits for approximately a year before determining our client no longer had verifiable restrictions and limitations that would prevent her from returning to her prior occupation. As is often the case with Cigna, this determination was made following the review of our clients medical records by a doctor who never examined our client. It is likely that had Cigna sent our client for an examination by an independent doctor her claim may have never been denied. Following receipt of the denial letter and after overcoming her initial shock our client contacted Attorneys Dell & Schaefer and spoke with Attorney Stephen Jessup.
The Administrative Appeal
Review of the denial letter and Cigna’s claim file yielded information that seemed to point to a denial of benefits based on Cigna’s review of our client’s activities of daily living, as opposed to how her conditions affected her ability to perform work related duties required of her job, such as the use of computers. Cigna went so far as to cite our client’s ability to host and cook Thanksgiving as evidence of her ability to work despite the fact that her records noted continued dizziness, double vision and possible seizure activity that prevented her from driving and affected her ability to use computers or electronic devices.
In reviewing our client’s medical history Attorney Jessup discovered that Cigna was not considering all of our client’s diagnoses when it denied her claim. Specifically, it was noted that the discovery of the brain tumor was a result of a previous bicycle accident in which our client hit her head. Cigna failed to note that the accident resulted in physical injuries to her spine that exacerbated multiple existing lumbar and cervical conditions. Additionally, she also suffered from multiple inflammatory conditions to include psoriatic arthritis. Although Attorney Jessup was confident that the strength of the medical evidence related to her vision problems was sufficient to win her appeal he focused considerable attention to compiling additional evidence of physical restrictions and limitations related to her pain conditions. This included the completion of a Functional Capacity Examination that not only indicated an inability to work due to these pain conditions but also noted how her vision problems affected her ability to perform required testing, which in turn confirmed how her vision would affect the performance of physical tasks in a work place environment.
Armed with additional medical statements from her multiple treating physicians and updated physical testing, Attorney Jessup submitted a thirty page appeal letter establishing our client’s entitlement to benefits as well as attacking Cigna’s arguments for termination of benefits. Prior to the expiration of the initial 45 day period to render a decision Cigna notified Attorney Jessup that it was overturning the denial of our client’s claim for disability benefits.
Cigna has paid all back benefits owed to date and Attorney Jessup continues to handle her claim in preparation of the 24 month change in definition of disability from “own occupation” to “any occupation.”
If you have any questions regarding a disability insurance matter please do not hesitate to contact our office to speak with Attorney Jessup or one of our other disability attorneys.