Disability Benefits Reinstated: Dell & Schaefer Appeal Gets CIGNA to Admit its Decision to Deny was Wrong

A former PACE Site Manager for Sentara Healthcare contacted our office after being referred to us by her Social Security Disability Attorney. After 4.5 years of being on claim, out of nowhere CIGNA denied her continued long term disability (LTD) benefits. She came to us after an appeal she filed on her own had been denied. Fortunately, the LTD Policy governing her claim through Sentara Healthcare allowed her the option of filing a second appeal.

Our client was forced to stop working in December of 2010 due to a laundry list of medical conditions. Her disabling conditions included: Systemic Sclerosis, Raynaud’s Interstitial Lung Disease, Fatigue and Malaise, Pulmonary Hypertension, Tachycardia, Cardiac Arrhythmia, Hypertension, Left Lower Extremity Deep Venous Thrombosis times 2, Bilateral Lower Extremity Chronic Edema, Bilateral Lower Extremity Leg Pain, Bilateral Lower Extremity Diminished Motor Strength, Rheumatoid Arthritis, Lumbar Spine Degenerative Disc Disease, Lumbar Spondylosis, Severe Right Foraminal Stenosis at Multiple Levels, Congenital Caudal Bony Canal Stenosis, Low Back Pain, Multiple Joint Pain, Diabetes Mellitus Type II, Shortness of Breath, Asthma, Morbid Obesity Status Post Gastric Bypass Surgery, Anemia and Depression.

As one might imagine, with this many issues, not only would she be expected to be unable to perform the duties of her own occupation, but it is reasonable to believe that she is unable to perform the material duties of any occupation for which she is, or may reasonably become, qualified based on education, training or experience. Unfortunately for her, after being paid benefits from June 9, 2011 through December 24, 2014, by way of a denial letter dated November 25, 2014, continued benefits were denied as CIGNA found that “an explanation of your functionality and how your functional capacity prevents you from continuously performing the material duties of any occupation are not clinically supported.” In support of this decision, CIGNA relied upon an “Independent” Functional Capacity Evaluation it had arranged which apparently showed that she was able to perform a sedentary occupation. Using the results of this evaluation, CIGNA denied continued benefits.

With this initial denial letter in hand, our client quickly filed an appeal on her own that merely stated “I am requesting an appeal regarding my long term disability, as soon as possible.” Three months later she followed up her appeal with limited medical documentation showing that she would be unable to perform the occupations that CIGNA stated she should be able to perform in the denial letter.

Her appeal was unfortunately denied by way of a 2nd denial letter dated January 20, 2015. With the latest denial letter, CIGNA relied upon a medical review by an Occupational and Internal Medicine Physician, surveillance footage and the previous Functional Capacity Evaluation.

Alexander Palamara of Dell & Schaefer Gets Involved

Within hours of being contacted, Attorney Palamara reviewed the denial letter and relevant medical records provided. Although time was extremely limited to file the 2nd appeal (only 60 days remained), we knew from what our client told us that we would be able to make a strong argument that CIGNA’s previous decisions to deny benefits were wrong. In fact, we believed that we would be able to show that the former PACE Site Manager for Sentara Healthcare would be unable to work ever again.

Review of the Claim File

After reviewing the claim file, we knew that the reviews relied upon by CIGNA were unreliable. Furthermore, the medical records we gathered showed objectively why our client should continue to receive LTD benefits. An administrative appeal challenging CIGNA’s ultimate determination was timely filed. The appeal questioned CIGNA’s reviews, evaluations and surveillance and pointed out that the overwhelming objective evidence found in our client’s medical records easily demonstrated her satisfaction of what it means to be disabled under the policy.

CIGNA Reinstates LTD Benefits

Within 90 days of the appeal being filed, CIGNA contacted our office and informed us that the denial of LTD benefits was being overturned. Our client is now receiving LTD benefits on a monthly basis.

Although she went without benefits for over a year, our client is happy to be back on claim. With the continued representation of Dell & Schaefer, she is confident that her benefits will continue for the life of her claim as she knows that we will do whatever it takes to keep her on claim. If you have been denied disability benefits by CIGNA or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.

Questions About Hiring Us

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   *****

Jack B.

I called Dell & Schaefer the day I received the LTD denial letter, and immediately spoke with attorney Cesar Gavidia. From our phone conversation he understood what I was up against. After my denial I was feeling hopeless and was ready to throw in the towel. Cesar explained to me the next step was to file a lawsuit and take the case before a federal judge. We settled the case at mediation with the insurance co. rep and their counsel.

***** 5 stars based on 202 reviews

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