Fresenius Medical Care North America Employee Wins Disability Appeal With CIGNA

Due to conditions that included Polyneuropathy, Encephalopathy, Osteomyelitis, Radiculitis, and Degenerative Disc Disease with Myelopathy, a Registered Nurse of Fresenius Medical Care North America was forced to stop working in June of 2012. Luckily for her, her employer provided coverage under a Long Term Disability (LTD) Insurance policy with CIGNA should she be unable to perform the material duties of her regular occupation for 24 months and then unable to perform the material duties of any occupation for which she is qualified based on education, training or experience for the time thereafter. Although applying for benefits was nerve wrecking, her claim for LTD benefits was approved and benefits were paid by CIGNA and commenced on December 11, 2012. Shortly thereafter, the Social Security Administration (SSA) also found her to be disabled and began paying Social Security Disability Benefits. Although her Social Security Disability Benefits allowed CIGNA to pay her at a decreased amount per month as they get to offset the money she receives from the SSA, her approval for such benefits gave her a false confidence that CIGNA would continue to pay benefits until her policy expired at age 65 or until she was able to return to work.

Denial of Continued Disability Benefits by CIGNA

As mentioned above, under the terms of this LTD Policy (and most Group LTD Policies), what it means to be disabled changes after 24 months of benefits are paid. For the first 24 months, in order to qualify for benefits, a claimant must prove that he or she is “unable to perform the material duties of his or her regular occupation” and that he or she is “unable to earn 80% or more of his or her indexed earnings from working in his or her regular occupation.” After 24 months of benefits, however, what it means to be disabled changes and becomes tougher to satisfy. At that time, in order to continue to receive benefits, a claimant must then prove that he or she is “unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience.” Furthermore, the claimant at that time must now be “unable to earn 60% or more of his or her indexed earnings.” Thus, after 24 months of benefits, it is an “any occupation” standard with a lower threshold of earnings capacity. This is often the time when insurance companies deny continued claim for benefits.

Unfortunately for this Registered Nurse of Fresenius Medical Care North America, CIGNA denied continued benefits beyond December 10, 2014, the date in which the change in definition of disability was occurring.

Claimant Filed an ERISA Appeal on Her Own

After receiving the LTD denial letter, the Registered Nurse filed an Appeal on her own to challenge CIGNA’s decision. This 3 page appeal was followed up with 2 more pages a week later that argued that she would not be hired for the positions that CIGNA believed she could do. Unfortunately for the claimant, CIGNA upheld its decision to deny her continued claim for benefits. Within hours of receiving the 2nd denial letter, the Registered Nurse contacted Dell & Schaefer for assistance in righting this wrong.

Alexander Palamara of Dell & Schaefer Gets Involved

After speaking with the claimant, Disability Attorney Alex Palamara knew that CIGNA’s decision was wrong. It was apparent that this Registered Nurse had disabling conditions that satisfied all the terms of the policy. The new denial letter allowed for an optional 2nd ERISA Appeal or allowed the claimant to file an ERISA lawsuit. Immediately upon agreeing to take on the case, Attorney Palamara ordered the Claim File from CIGNA and updated medical documentation from her treating providers. Upon receipt of all the documents, it was clearer than ever that the objective evidence proved that she is “unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience” and “unable to earn 60% or more of his or her indexed earnings.” Knowing that the claim file was not as strong as it needed to be and knowing that there was a high chance of success with filing an appeal, the decision was made to file a 2nd appeal instead of commencing litigation.

This 2nd appeal was timely filed. This appeal summarized all the medical records and made arguments as to why the Registered Nurse’s claim should never have been denied in the first place. On November 23, 2015, CIGNA informed us that “a determination has been made that the prior decision should be overturned.” On December 1, 2015, all the benefits that should have been paid from December 11, 2014 to that time period were paid. Although our client had not been paid for a year, she was relieved to be back on claim. She is also confident knowing that Dell & Schaefer continues to represent her as she knows it will help prevent CIGNA from denying her claim again in the future. She continues to receive her monthly benefit.

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, 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.

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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.

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Excellent legal services From Dell & Schaefer.

I had the opportunity to use the law firm of Dell & Schaefer of Hollywood, Florida. Greg Dell met with me during the initial consultation and explained my policy benefits. My situation was rather unique due to the fact it was a Mental/ Nervous condition which are often the most challenging to get approved. The firm spent a significant amount of time on my case and at a very reasonable fee. Through their hard work and legal expertise my claim was approved in a timely fashion. I would highly Greg Dell to anyone in need of a disability attorney.

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