Cal Van Steen had been employed as a Systems Integration Business Analyst at Lockheed Martin Corporation and participated in the company’s group long-term disability plan with Life Insurance Company of North America a/k/a CIGNA.
In 2011 while walking his dog he was assaulted during an altercation which resulted in a traumatic brain injury that affected Mr. Van Steen’s cognitive abilities, namely his abilities to concentrate, focus, organizational skills and maintaining deadlines. Mr. Van Steen sought care from his primary care physicians, a neuropsychologist and other specialists.
It was determined that the cognitive dysfunction from Mr. Van Steen’s traumatic brain injury prevented him from working in his occupation as a systems analyst, which lead him to apply for short-term and later long-term disability with CIGNA. Soon after submitting his claim, CIGNA approved Mr. Van Steen’s claim.
Approximately one year later, CIGNA reviewed the file and reached out to Mr. Van Steen’s doctors to discuss the claim and assess if he remained eligible for benefits. The neuropsychologist who had been treating Mr. Van Steen agreed to speak with CIGNA and informed them that Mr. Van Steen’s restrictions were permanent and not likely to improve.
The CIGNA long-term disability plan provided that should a claim be denied the insured must submit an appeal to CIGNA providing the reasons they disagree and documentation supporting their claim for disability. Mr. Van Steen submitted his appeal to CIGNA to which CIGNA responded that it was upholding its decision to deny his claim. Following CIGNA’s decision to uphold its decision to terminate the claim, Mr. Van Steen filed suit in the U.S. District Court for the District of Colorado, seeking relief by way of payment of all benefits owed by CIGNA as well as attorney fees.
After reviewing the administrative record and summary judgment motions submitted by Van Steen and CIGNA, the Court found that CIGNA had acted “arbitrarily and capriciously” by terminating Van Steen’s claim when nothing in his condition had changed; however, on the issue of attorney fees denied Van Steen’s request that CIGNA pay the legal fees he had incurred in having to sue CIGNA for his benefits. Following its defeat at the trial court level, CIGNA appealed the court’s decision to the 10th Circuit Court of Appeals seeking a reversal of the U.S. District Court judge’s decision. In response, Van Steen requested that the Appellate Court review the U.S. District Court’s decision to not award him legal fees despite his clear victory.
After considering the legal briefs and arguments submitted by both parties, the Appellate Court affirmed the lower court’s decision, stating that CIGNA had based its decision on reports from outside medical consultants, none who had determined from the medical evidence that Van Steen was capable of performing a sedentary occupation. The appellate court also found that Van Steen’s occupation required high level functioning and that there was no evidence of significant improvement in his condition.
However, as to the issue of Mr. Van Steen’s attorney fees, the appellate court also agreed with lower court on this issue, finding that there was insufficient evidence that CIGNA had acted in bad faith or that its arguments were wholly without merit.