Ladenburg Thalmann Branch Manager suffering from injured back sues CIGNA for denial of disability benefits

A disability attorney recently filed a federal ERISA lawsuit against the CIGNA Life Insurance Company of New York (CIGNA). The Plaintiff was forced to file suit after CIGNA repeatedly denied her disability claim.

The Facts of the Case Against CIGNA Life Insurance Company

Plaintiff suffered injuries that included bulging and herniated disks in her back in January 2004. She was examined and treated until it was determined that surgery was needed, resulting in her having a laminectomy to L4-L5 on March 21, 2005. This surgery was unsuccessful, which led to spinal fusion on L4-L5 on April 4, 2005.

After recovery from the above procedure, Plaintiff was hired as a Class I salaried employee by Ladenburg Thalmann & Co., Inc. on a full-time basis on or about June 15, 2005. Plaintiff was hired as a “Registered Representative and Branch Manager of Portfolio Management, Private Client Services.”

This job required her to do the following tasks:

Plaintiff had a Long-Term Disability Insurance Benefits Plan that was insured and administered by CIGNA. She became fully covered by this plan according to its terms on or about January 1, 2006.

On or about May 19, 2006, Plaintiff became totally disabled due to what was diagnosed as failed back syndrome.

On June 7, 2006, Plaintiff filed notice and proof of claim for disability benefits with The Hartford, which was the short-term disability insurance carrier for LTC. This disability insurance covered Plaintiff for the first 180 days of disability. The period where she received payments was from May 27, 2006 to November 24, 2006.

On November 23, 2006, Plaintiff filed an application for LTD benefits; the application that included “Proof of Loss” did not define exactly what proof of loss or when it was due.

Denial of CIGNA Disability Benefits Claim

On January 2, 2007, CIGNA denied Plaintiff’s claim on the basis of the Policy’s pre-existing condition provision.

Plaintiff appealed that decision by letter via certified mail on February 14, 2007.

Social Security Disability Benefits were awarded to Plaintiff on April 29, 2007.

On June 27, 2007, the New York State (NYS) Court of Appeals ruled that N.Y. Insurance Law Section 3234(a)(2) “allowed insurers to limit benefits during the first 12 months of coverage, but not permit them to deny all benefits for disabilities stemming from preexisting conditions and arising during that 12-month period.”

On July 31, 2007, after the 90 days allowed by the ruling, CIGNA reaffirmed its prior denial of LTD Insurance Benefits based upon Plaintiff’s pre-existing condition.

On October 11, 2007, Plaintiff requested a review of that decision.

On October 29, 2007, defying the NYS Court of Appeals ruling, CIGNA does not accept Plaintiff’s appeal of CIGNA’s previous denial of LTD insurance benefits.

On February 14, 2008, CIGNA recanted its former administrative claim position about the policy’s pre-existing condition provision as a basis for the denial of disability benefits and due to the NYS Court of Appeals ruling would request additional information to determine if Plaintiff was disabled and entitled to LTD insurance benefits.

CIGNA took 493 days longer than allowed by ERISA to request for more medical information from the Plaintiff and to receive an Independent Peer Review from a board certified physician. Michael J. Sukoff, M.D., (Sukoff) a physician licensed to practice in California expressed his opinion that Plaintiff was able to return to work and that her pain syndrome was not supported by all examinations. This opinion differed from every other physician who submitted a report to CIGNA.

Based on Sukoff’s review, CIGNA refused the claim of the Plaintiff and advised her that she can submit a written appeal within 180 days to appeal this decision.

Plaintiff submitted appeal and submitted documents regarding her right knee, right hand, lumbar spine, carpal tunnel surgery on right hand, discography of lumbar, cervical spine, and 2 epidural injections to the cervical spine.

CIGNA upheld its decision to deny Plaintiff’s claim on December 11, 2008, again advising her of the option to appeal this decision within 180 days.

Again, Plaintiff appealed, this time via letter on May 24, 2009. She also included the following with her appeal:

CIGNA claims that it tried to contact Plaintiff by phone to discuss her appeal, but that the phone number was “no longer in service.” Plaintiff disputes this by stating that the phone has been in service for “more than 14 years.”

On September 2, 2009, CIGNA again affirmed its earlier denial of Plaintiff’s benefits claim and that no further appeals will be considered.

Disability Lawyer Files Lawsuit Against CIGNA

According to the lawsuit, Plaintiff alleged that CIGNA failed to provide the following to the Plaintiff:

Plaintiff claims that CIGNA committed the following illegal acts:

Relief Sought By The Plaintiff In The CIGNA Lawsuit

Due to CIGNA’s actions, Plaintiff is seeking the following from the Court:

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