Dell & Schaefer Appeal Successful, Cigna reinstates Long Term Disability Benefits for Lockheed Martin Employee
Author: Attorney Alex Palamara
On January 15, 2010, a System Engineer for Lockheed Martin Corporation was forced to leave work due to multiple medical conditions. His conditions included Chronic Pain Syndrome, Degenerative Disc Disease of the Cervical and Lumbar Spines, Active Colitis, Cognitive Dysfunction, etc. As his employment with Lockheed provided coverage under a Long Term Disability Policy, this System Engineer applied for Long Term Disability Benefits with Cigna. Due to the severity of his conditions and their accompanying restrictions and limitations, Cigna approved the Lockheed Martin employee’s claim and he was paid benefits through August 17, 2012.
Denial of Benefits by Cigna
Unfortunately for the Lockheed Employee, by way of a letter dated August 16, 2012, Cigna informed him that benefits were being terminated effective August 17, 2012. In the aforementioned letter, Cigna stated that there were “no clear limitations and restrictions” and that it had found that the employee had “documented functionality.” Cigna therefore denied the claim.
Within hours of receiving this denial letter from Cigna, the Lockheed employee contacted Attorneys Dell & Schaefer for representation.
First Administrative Appeal Filed
After reviewing the claim file provided by Cigna and the medical records provided by the treating physicians, Attorney Alexander Palamara was confident in the Lockheed Employee’s case and filed a timely administrative appeal. This appeal stressed the level of support shown by the treating physicians and documented the objective evidence supporting the employee’s claim. Unfortunately for the Lockheed Employee, the first appeal was unsuccessful and his claim was again improperly denied by Cigna. The April 8, 2013 letter which denied the administrative appeal closely echoed the findings of Cigna’s initial incorrect letter of denial.
Second Administrative Appeal Filed
The Lockheed Martin Corporation Long Term Disability Group Policy provided for a second level of appeal to challenge Cigna’s denial of the employee’s administrative appeal. Armed with the same medical records previously provided to Cigna, as well as updated records and notes from the employee’s treating physicians, a second administrative appeal was filed which challenged Cigna’s decision to deny benefits.
CIGNA Overturns Denial, Long Term Disability Benefits Being Calculated
By way of a fax dated March 10, 2014, Attorneys Dell & Schaefer and the Lockheed Martin Employee were informed by Cigna that “a determination has been made that the prior decision should be overturned.” Cigna had thus overturned its earlier decisions to deny benefits and have thus reinstated the Dell & Schaefer’s client’s claim. A sizeable benefit check for the 19 months of back benefits owed will be received by the client shortly. This check in the tens of thousands of dollars will be for the period of August 18, 2012 to the present.
Additional Long Term Disability Benefits Will Follow
Because the claim has been reinstated and Cigna has now agreed that the client is “unable to perform each and every material duty of any occupation,” the client will again begin receiving a monthly benefit check from Cigna.
If you have been denied or are in fear of being denied by Cigna or any other of the disability insurance companies, please do not hesitate to contact an attorney at Dell & Schaefer for a free consultation. We will gladly review your claim to see if we can be of assistance.