Cigna Reverses Long Term Disability Denial And Admits Denying Benefits To Attorney Stricken With Parkinson’s Was Wrong
Author: Attorney Rachel Alters
A disabled Attorney sought total disability benefits due to severe Parkinson’s Disease with motor complications, secondary depression, drowsiness from medications, fatigue, right and left arm tremors and cognitive impairment which prevented him from being able to perform with reasonable continuity the material duties of his regular job as an Intellectual Property Attorney and partner at his law firm. CIGNA incorrectly determined that the claimant was not disabled on the date he filed for disability (January 3, 2011) as it was their opinion that his treating neurologist failed to provide sufficient objective evidence as well as documentation of the restrictions and limitations that prevented him from working.
The claimant was diagnosed with Parkinson’s Disease in August of 2004 at the University of Pennsylvania Movement Disorders Clinic. He was able to cope with his disease and manage to work as a partner in his law firm for approximately 4 years until his condition progressed to the point where this was no longer possible. In September of 2010, he noticed that his physical and cognitive condition has significantly declined to the point where it became necessary to reduce his work load, work hours and his billing fell by more than half of his pre-disability capabilities. During this time-period his treating neurologist who specialized in Parkinson’s Disease & Movement Disorders, documented that his cognitive and physical difficulties had progressed and he was only able to produce 50% of his normal workload due to confusion, fatigue, Bradykinesia and other symptoms which were interfering with his ability to perform his job duties. These were not self-reported symptoms, but symptoms observed by his physician while the claimant was present in the doctor’s office. By January of 2011, his conditioned significantly worsened to the point that he and his neurologist felt he was no longer capable of working.
Cigna Hired Psychologist to Render Opinions That Claimant Is Able to Work
Cigna hired a psychologist to review the claimants’ medical records and speak to his treating neurologist in order to render an opinion as to whether the claimant was disabled from his own occupation as of January 3, 2011. Cigna’s hired physician was not qualified to render such an opinion, as he is not a neurologist. He reviewed the records and determined that there was little documentation prior to March 26, 2012 to support preclusion of work capacity based upon psychiatric/neurocognitive impairments. He based his opinions on his review of neurology records, review of a neuropsychological report, and conversations he had with the treating physicians. Cigna was claiming that the claimant was not disabled in January 2011, but would be as of March 2012. In order for our client to collect benefits we had to prove that he was disabled at the time he stopped working, which was January 2011. Cigna was attempting to avoid payment on the entire disability claim.
Cigna’s hired physician had a conversation with the claimant’s neurologist regarding his condition, but failed to ask her if the claimant was unable to perform his occupation as of January 3, 2011. If he had she would have clearly told him that due to the progression of his disease, he could no longer work. She did tell him that the claimant was slow to respond and process things and slow to answer; he had problems multitasking and could not keep up with his job; and he was becoming stiffer and had more motor dysfunction over the past two years. His job required him to be able to multitask and think clearly on his feet. It also required extensive computer use and legal writing. Four months prior to his claim the claimant was no longer able to perform his essential job functions. He tried very hard to practice law to the best of his ability, but by January of 2011 this task became impossible. It is pretty clear that Cigna’s doctor was looking to give an opinion that would assist Cigna in denying our client’s claim and only asked the questions he wanted to hear the answers to.
Cigna Finally Approves STD and LTD Benefits After Failure To Pay For 22 Months
Prior to filing her ERISA appeals, Attorney Rachel Alters retained experts to review the medical records, speak to the claimant’s treating physicians, provide medical opinions and perform a neuropsychological examination of the claimant which all showed that he was disabled from his occupation. Attorney Alters then filed two extensive ERISA appeals on behalf of the claimant containing objective medical evidence in support of his disability. Cigna upheld their decision to deny benefits after the first appeal, but admitted they were wrong after they reviewed the second appeal putting him on claim and paying him twenty-two (22) months of past LTD benefits. Cigna finally agreed that our client was disabled as of January 2011. “We are extremely happy for our client and we hope that payment of disability benefits will help make his life a little easier as he manages his progressive medical condition”, stated Rachel Alters.
Attorney Alters will continue to manage his claim to help prevent future claim denial.