Anita Barajas has taken her disability claim to the United States District Court of Arizona in an attempt to force University Physicians, Inc. (“UPI”), CIGNA Group Insurance, and Life Insurance Company of North America to provide her the disability benefits she is entitled to. An Office Medical Specialist 2 for UPI, Barajas became disabled on July 8, 2008 when “fibromyalgia and Chronic Fatigue Syndrome (“CFS”), Sjorgen’s syndrome, and depression with memory loss” prevented her from performing her duties as an office medical specialist or any other occupation.
Barajas’s Disability Benefits Claim
A fully-qualified employee under UPI’s CIGNA Disability Insurance policy, Barajas’ Cigna Disability Application for long-term disability benefits was denied on December 2008 in large part because she had no records of psychological testing to prove her claim except for a MMPI administered by a rehabilitation professor. Consequently, Barajas underwent a detailed neuro-psychological evaluation conducted by a certified physician in September 2009. According to the report generated from this evaluation, Barajas has “cognitive difficulties, which prevent her from performing her duties as a medical specialist.”
Armed with this current neuro-psychological report, Barajas appealed CIGNA’s earlier denial of her disability benefits claim in October 2009, and was again denied in March 2010, CIGNA’s final denial. According to CIGNA’s denial letter to Barajas the insurer relied on the opinion of a Dallas rheumatologist who reviewed Barajas’s record on December 10, 2009. Unfortunately for Barajas, the rheumatologist did not have a copy of the October 2009 appeal letter from Barajas that included the neuropsychological evaluation of September 2009. Consequently the rheumatologist’s review caused CIGNA to deny Barajas’s benefits claim again.
Barajas Demands CIGNA Re-evaluate Her Disability Claim
Upon receipt of the final denial, Barajas requested that the last reviewer be provided with the missing neuropsychological report for further review. The requested document was sent to the rheumatologist and the doctor stated that as a rheumatologist he was unable “to comment on neuropsychological testing and any potential impairments suggested by such.” He suggested “the commentary would best be provided by a mental heal practitioner familiar with the detailed interpretation of [the] testing.”
Barajas demanded that CIGNA forward the report to a mental health professional, but was ignored. According to her CIGNA’s plan Barajas was within the 60 day period allowed to request further review of her claim when she was ignored, constituting a violation of CIGNA’s own policies and initiating Barajas’s filing of a Complaint on May 27, 2011 in the United States District Court of Arizona.
Barajas Turns To A Disability Attorney To File Her Lawsuit
Barajas and her disability attorney filed Barajas’s lawsuit pursuant to the Employee Welfare Benefits Plan Act (ERISA) 29 5 U.S.C. § 1002, claiming that CIGNA did not fulfill its fiduciary responsibilities toward Barajas in the provision of disability benefits per the terms and conditions of the insurance plan. As a participant in UPI’s CGINA Insurance Plan, Barajas rightfully expected that she was entitled to long-term disability benefits under the plan when she became disabled in July 2008. In her complaint, Barajas and her Arizona disability attorney allege that CIGNA’s breach of contract with Barajas was “arbitrary, capricious, an abuse of discretion, not supported by substantial evidence, and clearly erroneous.”
They allege that CIGNA’s decision to deny Barajas her disability benefits was “influenced by an improper conflict of interest,” and since Barajas had exhausted all administrative remedies, she was forced to initiate a lawsuit to force CIGNA to provide her promised disability benefits.
Barajas’s Lawyer States Barajas’s Case
Citing a Ninth Circuit opinion that states there is an “inherent conflict that exists when a plan administrator both administers the plan and funds, it,” and that to eliminate this dilemma, a fiduciary must show that he/she “labored under a conflict of interest” when making the decision to deny benefits for the decision to be valid, Barajas’s Arizona disability attorney alleges that CIGNA’s administrator did not make a correct decision in the case of Barajas. Thus, Barajas is entitled not only to her long-term disability benefits but is “entitled to reinstatement of any other employee benefits, which were terminated, discontinued, or suspended as a result of the termination of her disability benefits.”
Barajas and her Arizona disability lawyer have petitioned the United Stated District Court of Arizona to grant her:
- Payment of all past and future benefits under the terms of her CIGNA long term disability plan;
- Enforcement of her rights under the terms of that plan;
- Clarification and determination of Barajas’s rights to future benefits under the plan;
- Compensation for attorney’s fees and court costs; and
- Awards of prejudgment interest on benefits and damages and any other expenses the Court deems “just and reasonable.”