Is Cigna’s Denial of Your Appeal Really a Denial?

Following the submission of your appeal has Cigna sent you a letter stating that after review of the information provided on appeal their decision to deny your claim was correct but also providing you a copy of their medical reviews?

Recent changes by the Department of Labor to ERISA regulations now require that a disability insurance company provide you an opportunity to respond to adverse information created during the course of the review of your appeal. The DOL refers to this as the “Right to Review and Respond to New Information Before Final Decision” and states in the regulatory update:

Right to Review and Respond to New Information Before Final Decision. The final rule prohibits plans from denying benefits on appeal based on new or additional evidence or rationales that were not included when the benefit was denied at the claims stage, unless the claimant is given notice and a fair opportunity to respond.

Where many disability insurance carriers simply send a copy of their medical reviews while advising you that you and your doctors have a certain period of time to respond, Cigna, confuses the matter by starting the letter by stating the denial of your claim was correct. This has been causing a great level of confusion to disability claimants who believe that their claim has been closed.

Our office is seeing a large increase of these letters from Cigna. The fact that the letter reads incredibly similar to a formal denial letter makes it easy to overlook the fact that Cigna slips in a line or two about your right to respond to the reports or their doctors (or any other adverse information) created during the review of your appeal. It is important to note that Cigna will also toll the timeframe in which it has to review your appeal – meaning as soon as they send the letter Cigna will be allowed to legally suspend the review of your claim to the earliest date that (1) you provide a response to their medical review or (2) the date noted in the letter as the deadline to respond. If a disability claimant does not pay close attention to the deadline date or the information Cigna provides it can negatively impact their ability to provide additional information in support of disability with which to win their appeal.

There are a myriad of reasons that it is most advantageous to a disability claimant to have their claim approved during the first appeal with Cigna. The ability to respond to Cigna’s medical or vocational reviews prior to the formal denial of your appeal provides you a great opportunity, but failure to respond only strengthens Cigna’s position in the event your case ends up in court. If your claim has been denied or you have received a “denial but you have a chance to respond within 30 days before we formally deny your appeal” letter please contact our office to discuss your situation. Time is of the essence.

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Questions About Hiring Us

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.

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.

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It was a pleasure working with Dell & Shaefer. Mr. Palamara was very professional, courteous, and respectful of my situation. He worked quickly and efficiently to resolve my disability dispute with a positive outcome. The paralegal, Danielle, was extremely helpful and polite.

The firm of Dell & Schaefer was responsive to my request for assistance in obtaining the disability claim owed to me. I have only praise for their help in resolving my situation. Thanks.

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