• Trinity Health Care Registered Nurse Wins Cigna Long Term Disability Appeal

Trinity Health Care Registered Nurse Wins Cigna Long Term Disability Appeal

After receiving Long Term Disability (LTD) benefits for two years due to severe back conditions, a Nurse who formerly worked at Albany Memorial Hospital (which is part of the Trinity Health System) was denied continued LTD benefits after Cigna made a determination that she no longer satisfied the definition of disability under the policy.

The timing of such a denial is very common in the disability insurance world. As some don’t realize, most group disability insurance policies that are given to employees from their employers often contain fine print that states that the definition of disability (what it means to be disabled under the policy) changes after 24 months of benefits. Typically under most group policies, in order to qualify for benefits for the first two years, one most prove that he/she is “unable to perform the material duties of their own occupation.” Unfortunately, after two years, it then becomes more difficult to qualify for benefits as you now must prove that you are “unable to perform the material duties of any occupation you are qualified for based on your training, education or experience.” Insurance companies use this new definition of disability to deny many people on claim. In fact, it is the most common reason for a denial of a person on claim.

With regards to the Nurse who used to work at Albany Memorial Hospital, Cigna used the change of definition of disability as the reason to deny her claim. However, Cigna’s conclusions were blatantly wrong as there was no way that the former Nurse had the physical capabilities of performing any occupation for the rest of her life.

Cigna’s Denial

As justification for its denial, Cigna relied upon file reviews by its own employees. You read that right. Cigna did not have the Nurse seen by any doctor or medical professional. Cigna did not even have an outside/“independent” doctor perform a review of the Nurse’s medical records. All Cigna did was have its employee Medical Director and Claim Manager perform a review of the Nurse’s medical records. Thus, each of the people that Cigna relied upon to deny the claim had one thing in common: They were employees of Cigna and thus possessed an inherent bias in favor of the insurance company. These employees felt justified in disagreeing with the Nurse’s treating physicians who not only evaluated and treated her, but also supported the fact that the Nurse could no longer work at any occupation. Yes, these employees believed they had a better understanding of the Nurse’s conditions despite never evaluating her and not even laying eyes on her. It was what we call a purely “paper” review.

Dell & Schaefer Gets Involved and Files an Administrative Appeal

In addition to ordering updated medical records and gathering support from the many treating providers, Dell & Schaefer also had our client evaluated by a physical therapist who conducted a Functional Capacity Evaluation (FCE). The results of the FCE showed that our client had a physical demand capacity of less than sedentary work. Using this information, an appeal was timely filed. The appeal clearly pointed out the objective evidence which showed our client had the diagnoses she was complaining of. It also highlighted the years of support of the treating physicians. Lastly, it gave the results of the FCE. With this appeal, Cigna had no choice but to reapprove the claim.

Claim is Re-Approved

Roughly 3 months after the administrative appeal was filed, Cigna reinstated our client’s long term disability benefits. She is happy to be back on claim and she knows that Dell & Schaefer will do whatever it takes to keep her on claim through the maximum benefit period allowed under the policy.

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.

Questions About Hiring Us

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   *****

Emily H. (Massachusetts)

Rachel and team were professional, knowledgeable and competent in helping me with my disability insurance claim denial. I would not have been able to do this work myself successfully.  I had an illness best known as Chronic Lyme (I have more issues than that but that’s what I understood my diagnosis to be at the time of claim denial). This is a complex illness that is plagued with faulty testing, delayed diagnosis, inconsistent prognosis/ treatment outcomes, and vague (deniable) symptoms.

Advances in the disease’s treatment have stalled for decades due to financial & reputational conflicts of interest that exist across the healthcare/ insurance / government industries. It is a major thing to go against, and a very complex & constantly evolving issue, and Rachel was very familiar with all the chronic Lyme ‘inside baseball.’ Not many people want to get involved with anything Chronic Lyme-related if they have a choice. Finding an attorney that has expertise in this area is a rare find, and I can attest to the fact that Rachel meets this hard-to-find criteria and delivered results well beyond what I could have achieved without her.

***** 5 stars based on 202 reviews

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