As one can imagine, the occupational requirements of a Corrections Deputy Sheriff are physically and mentally difficult. Due to the risks of working in such a field, the Palm Beach County Sheriff’s Office provides a long term disability (LTD) insurance policy for all sworn Law Enforcement Division Deputy Sheriffs, Sergeants, Lieutenants and other qualified employees. Since 2004, this LTD policy has been with the Life Insurance Company of North America, which is commonly known as CIGNA.
After working for the Palm Beach County Sheriff’s Office for over ten years, due to various conditions that included cervicalgia, radiculitis, intervertebral disc disorder with myelopathy, cervical disc disorder with myelopathy, tear of medical meniscus of knee, right knee patella tendonitis and right knee chondromalacia, and osteoarthritis, a Corrections Deputy Sheriff was forced to stop work and file a claim for disability benefits under this LTD Policy in September of 2013.
Luckily for her, CIGNA initially approved her claim and benefits were paid through March of 2015. Unfortunately for this Corrections Deputy Sheriff, the approval for benefits was short lived and benefits were terminated as of March 5, 2015. By way of a denial letter of that same date, CIGNA terminated continued benefits after it concluded that “there are no documented findings that would preclude you from performing your own medium occupation.” As such, CIGNA closed her claim and further benefits ended. Dismayed by the denial, yet still disabled from not only being able to perform the duties of not only her own occupation but any occupation, the Corrections Deputy Sheriff knew the decision to deny was wrong. Within hours of receiving the denial letter, the Corrections Deputy Sheriff was on the phone with Dell & Schaefer to get assistance in filing an appeal to challenge CIGNA’s termination.
Alexander Palamara of Dell & Schaefer Files Appeal
During the initial consultation, it was apparent that CIGNA’s decision to deny continued benefits was flat out wrong. Due to the various conditions, it was clear that there was no way that the Corrections Deputy Sheriff could physically handle the requirements of her occupation.
Dell & Schaefer conducted an investigation into the claim. A copy of all CIGNA’s records were ordered and reviewed. Additionally, all of the medical records from our now client’s treating physicians were also gathered and studied. The result of our review was that there was no way our client could perform the “material and substantial duties of her regular occupation.” It was also concluded that it was doubtful that she would even be able to “perform all the material and substantial duties of any occupation for which… she may reasonably become qualified based on education, training or experience…”.
A timely appeal was filed with CIGNA. The appeal included arguments as to why CIGNA’s decision was not only wrong, but arbitrary and capricious as well. The appeal strongly showed that with her list of injuries, there was no way she could perform her duties as a sworn Law Enforcement Deputy. The appeal even noted that her conditions were so bad, she was even issued a Permanent Disabled Persons Parking Permit.
Within 60 days of the appeal being filed, CIGNA notified us that based on the appeal and information submitted in support of the appeal, “a determination has been made that the prior decision should be overturned.” 10 days later, a check for a significant amount of money arrived for the time period of March 6, 2015 to the present. Although our client was without benefits for nearly 7 months, she was happy to be back on claim. Furthermore, she knows that she can trust Dell & Schaefer to keep her on claim until she is able to return to work or until her policy expires at her Normal Social Security Retirement Age.
If you have been denied disability benefits by CIGNA or any other disability insurance company, please do not hesitate to contact Attorney Alexander Palamara at Dell & Schaefer for a free consultation.