CIGNA denies benefits after paying for 10 years, but Disability Attorney Stephen Jessup wins benefits for 60 year old client with fibromyalgia

For ten years our client was receiving long term disability benefits from CIGNA under an ERISA governed Group Disability Policy (Jaycor) due to a litany of medical conditions, which included Adult Onset Still’s Disease, Chronic Pain, Fibromyalgia and Fatigue. During the course of his claim and well prior to CIGNA’s termination of benefits, he had already met and passed the own occupation to any occupation definition change, had been approved for disability benefits by the Social Security Administration, and had even been approached by CIGNA on several occasions for a lump sum buy out of his policy. For all intensive purposes it would seem that at the age of 60 and the decade long history of his claim that CIGNA would not challenge the claim. However, CIGNA proved the adage that disability benefits are never guaranteed benefits.

In conducting a review of the claim, CIGNA first relied upon a paper review of the file conducted by its internal medical personnel. CIGNA’s medical personnel determined that our client’s medical records did not indicate an inability to return to work. These opinions were wholeheartedly and vehemently attacked by our client’s treating physicians. Based upon the treating physician opinions, CIGNA sent our client to a Functional Capacity Evaluation to determine his physical restrictions and limitations. Although CIGNA cited to the FCE as a basis for denying the claim, upon receipt of the claim file and review of the report, the FCE actually indicated multiple physical restrictions which would prevent him from working. CIGNA, however, only chose to cherry pick the portions of the exam, which supported its position to terminate his disability benefits. CIGNA also placed our client under video surveillance for a total of five days in a last ditch effort to justify the termination of his benefits. The video surveillance essentially only captured our client attending doctor’s appointments and then heading home, where he was not observed for the remainder of the day. It would seem that given all of the facts surrounding the claim that CIGNA would continue to pay benefits. Instead, CIGNA issued a denial letter.

Upon receipt of the denial he contacted our office to represent him for the purposes of filing an administrative ERISA appeal. Disability Attorney Stephen Jessup, a partner at Attorneys Dell Schaefer, dissected the claim file and discovered all of the glaring inconsistencies between CIGNA’s assertions in its denial letter and the actual documentation in the claim file. Mr. Jessup systematically attacked CIGNA’s position, using CIGNA’s own “evidence” against them, as well as supplementing the file with additional medical evidence in support of our clients continued disability and entitlement to long term disability benefits. The complete Appeal submitted by Attorneys Dell & Schaefer was 227 pages. Faced with an overwhelming amount of additional medical support and the realization they could not hide behind a seemingly “full and fair review” of the claim, CIGNA reinstated our client’s benefits.

CIGNA’s actions with regards to this claim are a reminder of the lengths an insurance company will go to deny benefits.

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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.

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Reviews   *****

Dr. Robert F.

A year ago in August I had the unfortunate situation where I injured my left hand playing in a recreational adult ice hockey game. My first reaction was fear, panic, and my work career is in danger. Having a job as a physician my hands are critical in day to day life but more important to do my job. I remembered at that point a local radio discussion about disability and knew that I had bought a policy 20 years ago and never thought I’d need it but always paid the policy just in case of a potential need.

I contacted Dell and Schaefer and I must say it was one of the best decisions of my life. Now my attorney, Cesar all I can say is THANK YOU! Michal THANK YOU! It at times going through the process was nerve racking scary but they walked me through it and always were there for my questions and concerns. When your life changes in one second you don’t know how to react. The group at Dell & Schaefer do. They understand not only what your going through but realise its individual for each client but always take a personal interest in your concerns. All I can say is my life has changed but choosing Dell & Schaefer to assist me in my claims process was one of the best decisions I ever made in my life

Thank you Cesar, Michal, and the whole firm. I’m with you for life.

Regards, Dr. Rob F.

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