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.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

View videos, articles, resolved cases and claimant reviews about your specific disability insurance company.

FAQ

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

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us