In a lawsuit against CIGNA Group, Paul M. and his Massachusetts disability lawyer allege that the insurer is guilty of:
- Unlawful and unreasonable denial of Paul M.’s disability claim even though it was provided with substantial medical evidence demonstrating his disability;
- Unreasonable interpretation of Paul M.’s CIGNA plan provisions that govern his disability benefits claim;
- A pattern of ignoring and/or rejecting substantial medical evidence that supports disability claims like Paul M.’s;
- Failure to Paul M. a fair review of his claim; and
- Failure to follow a reasonable claim procedure that takes into consideration the merits of Paul M.’s disability claim.
What the Massachusetts Claimant Wants
This lawsuit, filed in the United States District Court of Massachusetts on December 28, 2011 asks the Court to award Paul M.:
- Short term disability benefits as specified in the terms and conditions of Paul M.’s CIGNA Plan;
- An enforcement of the present rights as they exist in CIGNA’s policy;
- Clarification of Paul M.’s rights as provided in the terms of his CIGNA policy; and
- Recovery of interest, court costs and attorneys’ fees as provided by the Employee Retirement Insurance Security Act of 1974 (ERISA).
Denial of Assistant Vice President’s CIGNA Disability Benefits Claim
At the time of his succumbing to his disability, Paul M. was the Assistant Vice President of Meadowbrook Insurance Group. As a victim of Lyme disease (specifically, neuroborrelios), Paul M. stopped working on May 19, 2010. Two months later, on July 12, 2010, CIGNA denied his disability application based “solely on a selective review of his medical records,” according to the Complaint. Paul M. appealed CIGNA’s decision and returned to work in August 2010 “despite his ongoing symptoms and treatment due to mounting medical bills and his inability to support his family.” Paul M. was denied appeals to his claim on October 8, 2010 and June 2, 2010.
In their Complaint against the insurer, Paul M. and his disability attorney allege that CIGNA did not review Paul M.’s disability evidence and did not contact any of his “numerous treatment providers to discuss” his medical condition and limitations. The insurer, in its denial of benefits to Paul M.’s claim, stated that it denied his application because he did not provide “objective evidence” to support his disability. However, CIGNA does not require “objective evidence” according to the terms and conditions of Paul M.’s policy. Therefore, Paul M.’s disability attorney points out that the insurer has “failed to meet the minimum requirement for the denial of benefits,” and thus, did not satisfy the requirement under ERISA of a full and fair review of disability claims.
Consequently, Paul M. and his attorney ask the district court to rule in favor of Paul M. and against CIGNA so that Paul M. will be able to gain his entitled disability benefits.