Cigna reinstates Long Term Disability claim after reviewing Dell & Schaefer appeal

A client of Dell & Schaefer contacted our firm after receiving a letter from her disability carrier terminating her claim after paying for 24 months. Life Insurance Company of North America, also known as Cigna, paid benefits recognizing a disability based on PTSD (Post Traumatic Stress Disorder). Ms. T, had been working as a transplant coordinator for 14 years and her job required her to deal with families of deceased within 1 hours of death of the family member. The stress of the job eventually forced her to stop working.

In addition to her mental health condition, Ms. T suffered a stroke resulting in memory and cognitive issues that would cause her to get lost when driving even in familiar places. She also suffered from fibromyalgia, chronic interstitial cystitis, gastro intestinal issues and several sleep disorders.

According to the denial letter, Cigna had recognized that Ms. T was disabled due to her mental health condition and her policy contained a 24-month mental health limitation providing that the policy would pay a maximum of 24 months of benefits for disability due to mental health conditions. Cigna terminated the claim subject to this limitation and gave Ms. T the right to appeal.

The 24-month mental illness limitation is a common limitation in disability insurance policies and a common basis for a claim denial. However, often claims involve a mental health as well as a physical disability component and not all mental illness limitations are the same.

When Ms. T contacted our firm she indicated that she had severe limitations resulting from physical conditions but Cigna failed to properly evaluate the effects of those physical conditions.

The denial letter referenced Physical Abilities Assessment forms completed by two of Ms. T’s treating physicians. Based on the PAA forms, Cigna reached the conclusion that Ms. T would have the ability to perform a sedentary occupation as well as her previous occupation which was considered light duty.

While preparing the appeal, Attorney Peña and his team recognized several errors and inconsistencies in Cigna’s review. The PAA forms did not support Cigna’s conclusions. A careful read of the PAA forms indicated that Ms. T actually had less than sedentary work capacity although Cigna misinterpreted the report.

The appeal pointed out this inconsistency and provided additional evidence corroborating the treating physicians’ opinions. Attorney Peña arranged for Ms. T to undergo a Functional Capacity Evaluation which produced a report that was perfectly consistent with the PAA forms on which Cigna supposedly relied and which indicated less than sedentary work capacity.

The appeal also provided a detailed summary of Ms. T’s medical records that showed Ms. T had been suffering from physically debilitating symptoms long before the 24 month mark. These symptoms resulted from conditions that should not be subject to the 24-month policy limitation.

After reviewing the appeal, Cigna overturned its denial of benefits and reinstated Ms. T’s claim.

Dell & Schaefer continues managing Ms. T’s claim with Cigna.

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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