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:
- Plaintiff’s past due LTD benefits plus interest;
- Continuation of Plaintiff’s LTD monthly benefits payments per the terms of the plan;
- Payment of costs, disbursements and other expenses of the litigation; and
- “Such other further relief as this court deems just and proper.”
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.