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Missouri Court Rules Cigna Wrongfully Terminated Disability Benefits

In the case of Lapidus vs. Life Ins. Co. of N. Am. a Missouri federal court ruled against Cigna finding that Cigna wrongfully terminated long term disability benefits to Lapidus after having initially approving her claim for benefits. Prior to filing for disability benefits Lapidus worked as the vice-president of medical benefits for BJC Healthcare. Despite having undergone a spinal fusion and additional conservative treatment measures she experienced chronic back problems that resulted in her only being able to work in a reduced capacity. Under the terms and conditions of her employer’s disability policy with Cigna she made a claim for short and then long term disability benefits.

Cigna approved both her short term disability benefits as well as the long term disability benefit following the cessation of short term. However, the long term disability payments were short lived. After only eight months of payments Cigna advised Lapidus that it had found she was no longer considered disabled under the terms and condition of the policy. The denial was predicated on internal medical reviews that deemed a lack of evidence to support ongoing restrictions and limitations. Lapidus appealed Cigna’s denial and in doing so argued that there was nothing in her medical records to suggest that her condition had improved to a level that would allow her to return to full time work duties. Cigna ultimately upheld the denial of her claim and a lawsuit was filed in federal court.

Important to the Court’s ruling was the fact that the Court reviewed Lapidus’s lawsuit under a favorable de novo standard of review, which means the Court was only tasked with determining whether it believed Lapidus was disabled or not. This is an extremely favorable standard of review as opposed to the “arbitrary and capricious” standard of review found in the overwhelming majority of ERISA governed employer provided disability plans. In reviewing the facts of the case and reviewing relevant case law, the Court observed:

An insurer who first approves LTD benefits, then later terminates them, must show a “significant” change in claimant’s condition making her no longer eligible for benefits.

The Court relied on Lapidus’s doctors reports as well as gave significant weight to the results of a functional capacity examination, which indicated restrictions and limitations that would preclude Lapidus from performing the duties of her occupation. Additionally, the Court believed that Lapidus’s medical history to include her course of medication, surgical history, injections, spinal cord stimulator implantation, and objective diagnostic medical tests all supported the level of pain that Lapidus was experiencing.

The Court’s ruling was predicated on a straight forward evaluation as to whether Lapidus’s medical condition at the time of the denial was so different from the period of time in which Cigna had approved benefits to justify her benefits being terminated. The Court found it was not. The Court ordered Cigna to pay disability benefits owed top Lapidus but denied a motion for attorney fees filed by her attorney.

What can we learn from this decision?

As noted above, the Court reviewed Lapidus’s claim under the favorable de novo standard of review. Had the claim been subject to an Arbitrary and Capricious standard of review the outcome could have been much different. Additionally, although the Court found in Lapidus’s favor it must have not found Cigna’s conduct to be too egregious as evidence by the fact that it denied Lapidus’s attorney’s motion that Cigna pay her attorney fees. 

The Court provided common sense arguments based on applicable case law and gave examples of what information a Court will consider when determining disability and the importance of strong corroborating evidence to support complaints of pain.

It is clear from reviewing court decisions that many cases do not turn out as favorable as this one. For this reason it is imperative that an insured gather and provide as much evidence in support of his or her claim for disability benefits to not only stand the best chance in Court but to avoid having to leave their financial future in the hands of a court in the first place.

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Our firm had no part in Lapidus’s claim but feel it is important to report on pertinent Court ruling to better inform insureds who may be experiencing similar circumstances.

If your claim for disability benefits has been denied or you have questions regarding your claim please feel free to contact our office and speak to one of our disability insurance attorneys.

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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   *****

Anna P. (Iowa)

Mr. Jessup was able to secure approval for my benefits beyond the 2 year mark. This is a critical time as the evidence must show that you can’t work any occupation. By engaging him before the two year mark we were able to avoid a lapse in claims or erisa appeal.

Mr. Jessup was very professional, kind, flexible, and ultimately got results. The assistant on our case was Michal and she was amazing throughout the case. Very professional, quick to respond to questions, organized, and proactive.

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