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Court rules Cigna cannot use 24 month mental health limitation to deny disability benefits

Too many disability companies try to wrongfully use the 24 month mental nervous disorder limitation to deny long term disability insurance claims. How can Cigna pay disability benefits for 5 years and then claim a person should be limited to only 24 months of disability payments? In an ERISA Disability Lawsuit, a United States District Court in Oregon recently ruled that the Life Insurance Company of North America’s (LINA/CIGNA) decision to deny an individual’s continued receipt of long term disability benefits was incorrect. The Oregon Court found that CIGNA incorrectly applied the 24 month limitation for Mental Health claims in the policy and ruled that it was inapplicable to the individual’s claim.

Attorney Files ERISA Appeal Against Cigna Seeking Payment of Long Term Disability Benefits

The claimant worked as an attorney at a large law firm in San Francisco, California. Through his employment, he was covered under a Long Term Disability (LTD) Plan which provided monthly insurance benefits for disabled employees. While the policy will provide benefits for individuals whose disability is based on a mental health condition, the policy limits payments on such claims to twenty-four months.

After being diagnosed with Chronic Fatigue Syndrome, Fibromyalgia and Depression, the claimant filed an application for benefits on February 13, 2002. CIGNA promptly approved his claim the following month. From that time until 2007 (more than 5 years), the claimant received a monthly benefit of $5,000. However, on September 5, 2007, CIGNA terminated continued benefits. CIGNA based its denial under the Mental Illness Limitation. CIGNA felt that the claimant’s disability resulted from Depression rather than Chronic Fatigue Syndrome or Fibromyalgia. It is very common for disability insurance companies to argue that Fibro and CFS are mental nervous conditions, which is simply not true. The claimant timely appealed CIGNA’s decision, but unfortunately the appeal was also denied.

ERISA Disability Lawsuit Filed In Oregon Federal Court Following Cigna Appeal Denial

After the claimant had exhausted the administrative remedies, he and his Oregon ERISA Disability Lawyer (not D&S) filed a lawsuit in an Oregon Federal Court. In the lawsuit the claimant contended that his physical disabilities caused his mental health conditions which in the aggregate caused him to be unable to return to his regular occupation as an attorney. CIGNA, however, asserted that his cognitive difficulties arose from depression or a possible somatoform disorder, and, as such, the Mental Health Limitation applied. CIGNA also argued that the claimant had no physical limitations that prevented him from working his prior occupation.

The Oregon Court Finds in Favor of the Claimant and Reverses Cigna Disability Denial

After reviewing all the available medical documentation including the medical testing and the opinions of all the doctors involved, the Court ruled that the 24 month mental health limitation should not be applicable to the claimant’s case. The Court found that there was no convincing evidence that the depression, rather than Chronic Fatigue Syndrome, caused the claimant’s cognitive disability. Furthermore, the Court noted that recent Functional Capacity Evaluations found that the claimant had physical limitations that prevented him from performing the material duties of his prior occupation.

With the help of his Oregon Disability lawyer, this claimant was fortunate to be successful on his lawsuit to get back on claim for benefits. Although every case is fact specific, if you’ve been denied, please do not hesitate to contact Attorneys Dell and Schaefer for a free consultation to see how we may be able to assist you.

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There are 2 comments

  • Darryl,

    Please feel free to contact our office to discuss your claim. Getting around mental health limitations is extremely difficult depending on the definition used in the policy; the available objective medical evidence; and doctor support as to the basis of the impairment.

    Stephen JessupJan 5, 2016  #2

  • I have started to do battle with Cigna over their 24 month mental health clause. I have in writing that my issues stem from an organic problem. Although brain scans do not show any abnormality, a neuropsychological evaluation shows significant cognitive impairment in the frontal lobe and left quadrant. AKA brain injury. Thus my issue is physical and not just psychological. Anyone that can offer advice on how to battle this obvious discrimination, please feel free to. Thank you in advance.

    Darryl R.Jan 4, 2016  #1

FAQ

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, GoToMeeting.com 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   *****

Louis P.

I was a high earning medical professional who had a sudden practice ending injury in 2012 and I was fortunate to be recommended to Mr. Greg Dell for legal representation. From the time of our first meeting Mr. Dell and his staff have made my transition from practice very manageable with their handling of my claim. I would recommend Dell & Schaefer to anyone faced with the uncertainty of having to file a disability claim because in trying times a competent knowledgeable legal professional law office is invaluable.

Mr. Dell and his legal assistants and staff are expert in their field of disability claim handling removing the stress and burden at a time when we can be most vulnerable. Easy to communicate with, informed in every step in the claim process and always responsive to questions and concerns hiring Mr. Dell has been the silver lining in a very traumatic chapter in my life. Since my injury and as my claim has progressed I have spoken to others who are disabled and I feel blessed to have made the right choice in my legal representation.

Thank you

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