CIGNA under fire in Minnesota Federal Court for termination of claimant’s disability benefits

Plaintiff and her disability attorney filed a lawsuit against CIGNA in the United States District Court for the District of Minnesota in an effort to procure her entitled disability benefits.

A former employee of Medica Heal Plans (Medica) since May 26, 2006, Plaintiff became disabled in June of 2008 when she “developed increasing difficulty functioning” in the performance of her job due to “various medical problems. These medical problems included “rheumatoid arthritis, ovarian cancer, the after-effects of chemotherapy for ovarian cancer, fibromyalgia, chronic fatigue syndrome, lymphedema, peripheral neuropathy, obstructive sleep apnea, irritable bowel syndrome, and depression.”

Claimant was initially awarded disability benefits

Plaintiff applied for her ERISA-governed CIGNA disability benefits and was awarded long term disability benefits in June 2008. Subsequently, Plaintiff applied for and was awarded Social Security Disability Insurance benefits (SSDI), and adhered to CIGNA’s requirement that her disability benefit payments be reduced by the amount of SSDI she received. Plaintiff’s SSDI payments began on September 1, 2008. Then on December 30, 2008, per the terms and conditions of her CIGNA insurance policy, Plaintiff received a waiver on premium payments for her CIGNA life insurance plan.

In April 2009, Plaintiff contacted the insurer and asked for “assistance in making a return to some work.” Hoping to be able to return to part-time employment, Plaintiff signed a Rehabilitation Plan Agreement with CIGNA. After complying with the rehabilitation plan, Plaintiff and her vocational counselor informed the insurer that Plaintiff was looking for a work-at-home opportunity. As such, Plaintiff began working part time for J. Lodge on October 2009 from home by propping up in a chair or in her bed to participate in her new job.

Claimant’s disability claim “red-flagged” as fraud by CIGNA

Unbeknownst to Plaintiff, as a result of her part time work, Plaintiff’s claim was red-flagged for a fraud investigation. The basis of this investigation was that: “(1) Plaintiff was working from home; (2) Plaintiff had too many doctors; [and] (3) Plaintiff was perceived as ‘defensive and aggressive’ when asked about her work limitations.” Surveillance was ordered on Plaintiff by the insurer which captured Plaintiff traveling to a medical appointment and shopping for groceries.

After her claim was reviewed by a CIGNA nurse, who reviewed only a portion of Plaintiff’s medical information, Plaintiff was informed in a letter on March 30, 2010 that it had been determined that she was able to work in any occupation, and her disability benefits would be terminated. Plaintiff appealed the decision, underwent a functional capacities evaluation (at her own expense) and was evaluated for her function ability to return to full-time employment. It was determined that she was precluded from performing any full-time work, including sedentary work. Plaintiff’s records were then forwarded to a CIGNA internist for review, with the internist opining that Plaintiff’s evaluation was wrong and Plaintiff was not disabled.

Claimant’s Life Insurance Benefit Plan Administrator considers Plaintiff disabled

About the time of all this investigation, Plaintiff’s Life Insurance benefit plan was transferred to the care of UnitedHealthcare Specialty Benefits, who continues to waive Plaintiff’s premium payments as according to this company Plaintiff remains disabled. Plaintiff submitted a second appeal to CIGNA in an effort to retrieve her disability benefits from the insurer, along with proof of the validity of her functional capacities evaluation with a refuting opinion of the pervious internist’s opinion to no avail.

CIGNA claimant engages a disability attorney

Consequently Plaintiff had no other option but to hire a disability attorney to file the subject lawsuit against CIGNA. Asserting that Plaintiff has “satisfied the applicable definition for disability under the LTD [(long term disability)] plan,” is being “wrongfully denied benefits under the LTD plan,” and is a victim of CIGNA’s “breach of the LTD plan and ERISA for terminating disability benefits,” Plaintiff’s attorney asks the District Court for:

In the above referenced case our firm did not represent the Plaintiff and had no involvement in the case. The plaintiff in this case was or is represented by a Minnesota Disability Lawyer that is not in any way affiliated with our firm. The information in this post comes from our review of a Complaint that was filed in Federal Court as a public record. This post has been modified from a previous version.

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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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