Prior to filing for disability in June of 2012, our client was a Certified Drug Coder for a large hospital network. She had been suffering with severe lumbar back pain that was making it increasingly difficult to sit for long periods of time without experiencing severe pain. Due to the nature of her occupation and company policy she was restricted in her ability to take her prescribed pain killers as they affected her mental acuity. Despite her best efforts to cope with the ever increasing pain she reached a point where she could no longer effectively perform the duties required of her. Like many people, her employer provided short and long term disability coverage in the event she were to become unable to work.
Our client submitted an application for disability benefits with Cigna. Her initial short and long term disability claims were initially approved. Despite being out of work her pain continued to become more severe and six months after going on disability she underwent low back surgery. Shortly thereafter she was notified that Social Security had also awarded her Disability benefits. Taking all factors into consideration it would appear that our client would have little to worry about with her Cigna claim, and for a year and a half, such was the case.
Denial of Benefits
Like so many people on long term disability, without warning she received a letter from Cigna that her claim was being denied due to a lack of “clinical evidence” to support the inability to perform the duties of her former occupation. In the denial letter Cigna employed a very common tactic to minimize the nature of our client’s occupation by reducing the duties down to the physical demand level assigned to the job by the Department of Labor. In our client’s case, Cigna argued that her ability to perform the duties of her occupation was based solely in her ability to perform Sedentary demand level work, and that based on their review she would be able to work full time in a such a capacity.
Shortly after her claim was denied she contacted Dell & Schaefer and spoke with Attorney Stephen Jessup regarding her case and her very real concerns that she would not be able to afford to pay her bills without her disability benefit from Cigna. Attorney Jessup set to work quickly to obtain a copy of the administrative records and arrange additional testing for our client. In drafting our client’s appeal, Attorney Jessup was quick to point out that Cigna’s review and consideration of our client’s award of Social Security disability benefits was in direct violation of the Regulatory Settlement Agreement Cigna had recently entered into based on its improper claims handling. Although receipt of Social Security is not a guarantee that benefits will be paid under a group or private disability insurance plan, it is strong evidence in support of disability, especially when the award of SSDI is contemporaneous to the time of a denial of benefits, and as was the case with our client – when the definition for total disability is in the “Own Occupation” stage, which is a much less strict definition than the SSDI “any occupation” standard. Attorney Jessup went on to attack Cigna’s vocational review as it did not take into consideration the non-physical required duties and in doing so failed to review our client’s entitlement to benefits based on the policy language. When all additional testing, medical records, and updated support from her doctors were received, Attorney Jessup submitted our client’s appeal.
Upon review of the Appeal, Cigna overturned its denial of benefits, reinstated our client’s claim and paid all back benefits owed. However, as is the case with many people whose claims have been denied during the “own occupation” definition of disability, Cigna has already advised that it is beginning to conduct its review for continued benefits under the any occupation period. Attorney Jessup had already anticipated this next step and began building additional evidence in support of disability into the any occupation stage. Our office continues to represent our client and stands ready to continue any fight to ensure he continues to receive her rightful benefits.
Don’t let your insurance carrier bully you.
If your claim has been denied, or you are concerned that your insurance company is attempting to deny your benefits, please feel free to contact our office for a free consultation to discuss your rights.
Visit our website section about CIGNA disability claims. You can also learn more about chronic pain disability insurance claims.