Dell & Schaefer Successfully Appeals Denial of Benefits to Former Clinical Therapist

Mr. S contacted our firm for help fighting CIGNA after receiving a letter cutting off his benefits. He had received less than a year of benefits when CIGNA scheduled an Independent Medical Examination (IME) due to a lack of response from Mr. S’s treating physicians.

Some carriers, like CIGNA, will immediately exercise their right to schedule an IME if they request claim forms from doctors and do not receive them. In some ways this is a good thing since there are some insurance companies that merely stop paying benefits when they do not receive requested claim forms from treating physicians. Usually, when benefits are terminated, the carrier will force the claimant into the appeals process which often leads to other problems down the road. CIGNA however, rarely wastes any time scheduling an IME. The problem in this situation is the claimant is now at the mercy of the hired physician and CIGNA will rely on whatever the IME doctor reports back to CIGNA.

Mr. S failed to show up to the scheduled IME and did not respond to any of CIGNA’S attempts to reschedule the appointment. Naturally, CIGNA ceased payment of benefits. While we never recommend simply refusing to attend an IME—given the claimant cooperation provision in most disability policies—in this case Mr. S may have avoided introducing negative reports into the file since doctors hired by insurance companies are known to often serve as a basis for a denial of benefits.

Mr. S contacts Dell & Schaefer following receipt of his denial letter

Rather than submit to the IME Mr. S was able to submit the Physical Ability Assessment (PAA) forms that had originally been requested by CIGNA. Unfortunately, the forms were not enough. In June 2017, Mr. S received a letter from CIGNA stating that benefits were terminated and he had the right to submit an appeal.

Mr. S contacted our office and we accepted Mr. S’s case. Our team immediately began working on Mr. S’s appeal. After reviewing the claim file and medical records it became apparent that Cigna had not given Mr. S a fair assessment. The medical records contained an abundance of evidence supporting Mr. S’s claim. The claim file contained documented errors by CIGNA including diagnoses that did not apply to Mr. S. It appeared the nurses reviewing Ms. S’s file had downplayed the severity of Mr. S’s condition such as describing significant spinal issues as merely a “lumbosacral sprain.”

The claim file also contained a report from CIGNA’S Medical Director that contained conclusions in complete contradiction with the available medical records. Cigna’s entire foundation for denying the claim seemed more and more unreasonable the more the file was reviewed.

To provide objective evidence of the extent of Mr. S’s functional limitations Mr. S underwent a Functional Capacity Evaluation (FCE). Unsurprisingly, the FCE revealed that Mr. Stewart’s functional ability was below sedentary, meaning that he was not only unable to perform his occupation as a Clinical Therapist but also any sit down job. The FCE report was submitted with the appeal, along with detailed physician questionnaires, a fully favorable Social Security Disability Award notice and a very detailed breakdown of the deficiencies found in CIGNA’S review.

Not long after submitting the appeal our office received notification from CIGNA that they would be overturning the denial of benefits and issuing all back benefits owed.

While Mr. S continues to receive benefits from CIGNA and continues to be represented by Attorneys Dell & Schaefer CIGNA will continue to perform similar reviews as long as Mr. S is on claim. This case is a perfect example of how easy it is for your claim to be denied despite having substantial evidence of disability. It is important to always be one step ahead of the insurance company and never let your guard down.

If you have a similar case with CIGNA or any other disability company feel free to contact our office for a free consultation.

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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.

Reviews   *****

Lisa P.

When I became disabled I filed a claim with my insurance company and they denied my disability payments. After failed attempts to resolve it myself I finally reached out to Dell & Schaefer. They were able to get me a settlement. I know I would never have won my case because I didn’t have enough evidence from my doctors due to losing my insurance and not going to the doctor much. But Rachel was able to get me a settlement. Not only that, but she got me double what the insurance company originally offered. I would describe my experience working with them as pleasurable and professional. You just can’t go wrong with this firm!

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