Dell & Schaefer Wins Disability Appeal against Cigna for Mortgage Banker
Author: Attorney Victor Peña
Before contacting our office, Mr. Z had a long history of chronic cervical issues necessitating repeated surgeries, the most recent being in March 2014. In addition to other issues, Mr. Z had been suffering from worsening symptoms associated with headaches and upper extremity weakness due to cervical herniated disc with myelopathy. In September 2013, Mr. Z’s conditions had worsened to the point he was no longer able to work as a Loan Officer for Quicken Loans.
Luckily, Mr. Z was eligible for Short-term disability (STD) benefits through his employer sponsored group disability plan. CIGNA, the claims administrator for the STD plan, initially approved Mr. Z’s claim for benefits and paid him benefits through December 13, 2013.
Mr. Z was also covered by his employer’s Long-term Disability (LTD) plan, under which he was eligible for benefits after exhausting his STD benefits. However, relying on an estimated return to work date from Mr. Z’s doctor, CIGNA denied Mr. Z’s LTD claim beyond December 20, 2013.
CIGNA denied Mr. Z’s claim despite an update from Mr. Z’s doctor that Mr. Z’s condition had worsened and advising that Mr. Z is not to return to work on December 20. CIGNA also ignored the doctor’s statement that Mr. Z required additional surgery.
First Administrative Appeal
Mr. Z, with the help of his doctor, submitted an appeal of CIGNA’s denial of benefits. Mr. Z took on the burden of handling his appeal while suffering through intense pain in his neck, daily migraines, swelling and pain mixed with numbness in his ear.
Despite letters from Mr. Z’s doctor, MRI’s revealing the origin of his pain, EMGs showing chronic cervical radiculopathy as well as statements from Mr. Z’s doctor that he was in need of additional surgery to stop the pain, CIGNA denied Mr. Z’s appeal on February 4, 2014.
Voluntary Appeal by Dell & Schaefer
Luckily, Mr. Z had a second appeal available under his policy and, following the denial of his appeal, he contacted our office for help.
Attorney Victor Peña immediately began working on Mr. Z’s case. Upon reviewing the claim file, it became apparent that CIGNA’s review had been less than thorough. Cigna had denied Mr. Z’s claim based on outdated medical documents and had ignored significant objective findings supporting Mr. Z’s claim.
Attorney Peña sorted through the claim file and determined what was needed to get Mr. Z’s claim overturned. The appeal was successful.
By letter dated September 24, 2014, CIGNA faxed notification overturning its denial and advising that it would pay all benefits owed.
Find more CIGNA disability cases discussed on this page.