Life Insurance Company of North America overturned previous denial of long term disability benefits for Washington Crime Scene Photographer

Our client, Mr. B, formerly worked as a Crime Scene Photographer for Sherriff’s Department. In December 2012 a number of medical issues including, chronic pain syndrome, non-traumatic incomplete quadriplegia, chronic and severe neck and back pain, coronary artery disease forced Mr. B to stop working and submit his claim for disability benefits first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy. Both benefits were funded and administered by Life Insurance Company of North America (CIGNA). Under his employer’s disability policies Mr. B would be considered totally disabled after 24-months if he was unable to perform the material and substantial duties of any gainful occupation, which was defined as any occupation he was qualified to perform by education, training and experience and considering any/all documented functional restrictions and limitations.

After paying Mr. B for more than 2 years under the LTD Policy, CIGNA denied further LTD benefits on the basis that he allegedly no longer met the policy definition of disability. Specifically, CIGNA determined that Mr. B “would be able to work in light occupations…and therefore [he] would be able to perform in [his] regular light occupation.” After receiving the denial, Mr. B contacted Dell & Schaefer and discussed his 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 Mr. B’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 (a) the physical capabilities assigned to Mr. B by CIGNA’s medical records reviewer were incorrect and unreasonable; (b) CIGNA incorrectly determined that Mr. B could perform his regular “light” occupation; and (c) the available medical information confirmed that Mr. B was and continued to be unable to perform his regular occupation or any other occupation. More specifically, CIGNA’s medical reviewer failed to discuss or even mention relevant medical information in an attempt to mischaracterize the significance of his complaints and purportedly support that Mr. B had light duty capabilities. Further, CIGNA’s vocational reviewer incorrectly and unreasonably concluded that Mr. B’s occupation required Light capabilities when the evidence clearly supported that his occupation required, at least, Medium capabilities. In support of this argument, Attorney Symonds retained a vocational expert who clearly established the Medium level requirements. And finally, to confirm Mr. B’s functional levels, he attended a Functional Capacity Evaluation (FCE) which clearly established that he had less than Sedentary functional capabilities.

Approximately four 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. B’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.

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FAQ

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   *****

Brett C.

I have been on LTD, since Aug 2016, and Cigna is my LTD Insurance Company. I received a couple of payments from Cigna, without any issues, but then the payments stopped in Oct, at which time I was informed by Cigna that they were “looking into” my claim. Cigna stopped contacting me, would not even return calls or emails, but finally contacted me in mid-December to inform me that they would not be continuing with my claim.

I contacted Dell & Schaefer in January, at which time I began working with Attorney Alex Palamara, Disability Appeal Specialist Randa Escayg, and Legal Assistant Kathy Bordes. These folks were always kind, professional, understanding, did a great job of explaining everything to me, and most importantly I could tell that they truly cared about the situation my wife and I had unfortunately found ourselves in.

I fully understand the feeling of being overwhelmed, when you are first denied, that David vs Goliath feeling of you against some huge conglomerate, that powerless and helpless feeling that overcomes you when you are sick and injured and at your most vulnerable. The only things that you are able to focus on are saving your family’s home, doing whatever you can to take care of them, all while you should be focusing your energy on getting better, as much as you are able, so that you can recover your life to what it once was, returning your current life of overwhelming stress and chaos to some semblance of normalcy. Well, as soon as I began working with Alex, Randa, and Kathy, I immediately felt better, like I finally had someone in my corner fighting for me, somebody who cared, and somebody who would stand up to that giant corporation, and make things right.

Alex won my appeal for me, and Cigna is in the process of restoring my full benefits, retro back to October. I cannot describe to you the feeling of joy and elation the moment my wife and I were notified we had won. To those currently dealing with a LTD company, and all of the madness that entails, just know that there is a light at the end of the long dark tunnel. You do still have hope, and you can certainly do no better than to have the wonderful folks at Dell & Schaefer in your corner fighting for you!!!!

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