Cigna reverses its decision to terminate benefits of a claimant with Fibromyalgia, Cervical Spine Spondylosis and Depression

After paying the claimant for 24 months under the mental nervous condition limitation, Cigna terminated her benefits based on the lack of evidence supporting her physical disability. In its denial letter, Cigna dismissed the overwhelming volume of objective evidence supporting the claim for total physical disability (ie, significant abnormal findings on objective diagnostic testing, her credible complaints of pain, and clear observed limitations by her board certified physicians and specialists). However, it had always been the claimant’s contention that she was disabled and unable to work due to her multiple physical medical conditions which include Severe Fibromyalgia, Diffuse Myofascial Pain, Left Knee Pain, Cervicalgia, Insomnia, Cognitive Impairments, Cervical Spine Spondylosis, Bilateral Carpal Tunnel Syndrome, Bilateral Shoulder Pain, Bilateral Hand and Wrist Tenosynovitis, Headaches, Bilateral Neuropathic Upper Extremity Pain, Myofascial Pain Syndrome, Hypersensitivity Syndrome, Sacroiliac Inflammation and Anxiety and Depression secondary to her physical conditions. In an effort to avoid having to pay the claimant for greater than 24 months, Cigna conveniently labeled her claim “mental nervous” when the evidence in the records clearly demonstrated otherwise.

Cigna’s hired physician consultants to render opinions that the work restrictions imposed by her treating physicians were not supported by the documented measured limitations and there were no specific clinical limiting findings on physical examination. This of course was false.

After the claimant’s benefits were terminated, she retained Attorney Rachel Alters of Dell & Schaefer to help fight Cigna’s denial of her claim. Attorney Alters aggressively worked up her claim, recommended additional testing be done and obtained expert opinions from her treating physicians and filed an extensive appeal on her behalf.

Claimant was Involved in Car Accident During the Course of Her Claim Which Cigna Completely Ignored

The claimant was involved in a motor vehicle accident in August 2013 which exacerbated her fibromyalgia pain and caused unremitting stabbing pain in the lower back and hip which prevented her from sitting for prolonged periods and was relieved only with lying down. The medical records revealed at least 11/18 fibromyalgia tender points, decreased range of motion of the cervical and lumbar spines in all planes, increased pain with extension, and motor exam that was limited by pain in the upper and lower extremities with give way weakness. Cigna ignored all of this medical evidence and claimed that she was disabled only due to depression and anxiety for which benefit were only available for 24 months.

A Functional Capacity Evaluation Reveals that Claimant is Physically Disabled from Any Gainful Occupation

In order to refute Cigna’s claim that her claim was solely mental nervous, the claimant underwent a Functional Capacity Evaluation. According to the physical therapist, the claimant performed with maximal effort, her performance was consistent among FCE items, and her perceived abilities were consistent with her functional abilities objectively identified during the FCE. She reported a pain level of 7/10 at the start of the evaluation and 10+/10 upon completion of the FCE. It is noted that the testing had to be modified in order to allow her to be able to perform waist to floor lifts and kneeling. She moved in a slow manner with walking and transfers. She has slow gait with low heel contact and intermittent foot drag and catching of the left foot. She has a resting tremor present in the bilateral upper extremities. She had difficulties with tasks requiring her to lift/lower objects below waist level, is unable to fully squat or crouch due to weakness, and is limited to occasional walking due to slow gait with low heel contact and intermittent foot drag and catching of the left foot. She is limited with negotiating stairs due to lower extremity weakness and walking limitation. She is unable to carry items frequently due to her walking limitations. She has below average grip strengths of bilateral hands, poor hand coordination for bilateral hands. Her scores on pain screening questionnaire indicate a relatively high risk for developing long term problems. This was clearly not a woman that was solely suffering from depression and anxiety.

The FCE report was submitted to Cigna along with her appeal. Cigna eventually overturned its decision to terminate benefits, paid the claimant her past benefits owed and put her back on claim admitting that her disability was physical and therefore not limited to 24 months. Attorney Alters will continue to manage her claim to help ensure her benefits continue to be paid by Cigna.

Read more about fibromyalgia disability claims and about 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.

Dell & Schaefer Client Reviews   *****

Marna L. (Tennessee)

When the letter arrived from the insurance company that they would no longer be making payments to my disabled spouse our world came to a stop. This is a devastating moment. Rather shocking since we had complied with all the requirements. Shortly, thereafter I started researching to find the best legal firm to represent my spouse. After reading the numerous ads for legal firms I came across Dell & Schaefer. Read the material, listened to the you tube and read the booklet. The process was fast once I place the call.

Attorney Jay Symonds returned my call. He was amazing and talked me through the process. He went through the details as to what would be needed several times. He has patience which is needed when dealing with people under stress. Mr. Symonds was open to different types of communication and at odd times of the week and day. He was understanding of my time as a full time caregiver. Through the process Mr. Symonds and his staff stayed in contact with me. End Result: My spouses insurance was reinstated. We are very grateful to Jay Symonds and his team.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us