Life Insurance Company of North America (CIGNA) overturned previous denial of long term disability benefits for Massachusetts Senior Advisor

Our client, Ms. G, formerly worked as a Senior Advisor for a large financial services company. In March 2015 a number of co-morbid physical conditions and ailments forced Ms. G to stop working and submit her claim for disability benefits first under her employer’s short term disability (“STD”) Policy then continuing under her employer’s Long-Term Disability (“LTD”) Policy both benefits were administered and funded by CIGNA. Under both of her employer’s disability policies Ms. G would be considered totally disabled if she was unable to perform the material duties of her regular job, which was defined as the occupation she normally performed for her employer.

After paying Ms. G for more than 8 months under the LTD Policy, CIGNA denied further LTD benefits on the basis that she allegedly no longer met the policy definition of disability. Specifically, CIGNA determined that “there was no indication that the frequency and severity of her complaints of pain were so constant that she was functionally limited or would have required any specific restrictions and/or limitations.” After receiving the denial, Ms. G contacted Dell & Schaefer and discussed her case with Attorney Jay Symonds. Attorney Symonds identified several significant issues in CIGNA’s denial letter and in the evidence it relied on and agreed to prepare and submit Ms. G’s ERISA appeal with the assistance of his appeal team.

The LTD appeal addressed all of CIGNA’s short-comings and reasons for denial, with a special focus on the medical records on and around the date of CIGNA’s denial. The appeal next addressed the fact that CIGNA’s medical reviewers relied on an unsubstantiated and erroneous position that Ms. G’s orthopedist’s medical assessment and opinion was not well supported by medically acceptable clinical or laboratory diagnostic techniques and that their vague claim that it was inconsistent with other unidentified (and nonexistent) substantial evidence in the file. What’s more, the medical reviewers disregarded her orthopedist’s medical opinion which was based on repeated objective medical testing (MRIs, EMG/Nerve Conduction Studies, X-Rays), repeated ineffective invasive procedures (Nerve Blocks, Steroid Injections, Radiofrequency Lesioning) and repeated in-person physical examinations of Ms. G as well as the contributing opinions of specialists in Pain Management, Neurosurgery and Orthopedic Surgery. The available medical records clearly established that Ms. G was undergoing regular treatment for her chronic medical conditions and that the objective testing conducted and multiple unsuccessful invasive procedures all supported and confirmed Ms. G’s stated restrictions and limitations. CIGNA’s medical reviewers’ oversimplification of Ms. G’s complex medical history was not the result of a full, fair, thorough and honest investigation of her claim. Accordingly, the reviewers’ opinions were fatally flawed and it was unreasonable for CIGNA to rely on them in support of its denial of LTD benefits.

Two months later, and after reviewing the appeal and hundreds of pages of exhibits and medical records as well as the expert reports, CIGNA overturned its decision to terminate benefits, paid full LTD back benefits and reinstated Ms. G’s LTD claim. Attorney Symonds continues to represent our client to best ensure that CIGNA will not terminate his benefits again. Feel free to call our disability attorneys for a free consultation on this or any matter relevant to your disability claim.

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.

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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