Attorneys Dell & Schaefer successfully appeal denial of benefits to claimant with CRPS/RSD

Ms. S contacted our firm after receiving a letter from her disability carrier, Cigna, denying her claim for short term disability benefits under her employer sponsored disability plan. Ms. S was suffering from multiple ailments including a rare, often misunderstood condition called Complex Regional Pain syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD). At the start of the claim, Cigna accepted the evidence submitted by Ms. S and her treating providers and paid two months of benefits. However, Ms. S’s condition had not improved before she received a letter from Cigna indicating benefits would not be payable beyond those two months.

Cigna denied ongoing benefits stating that “the medical information provided to date does not provide any symptoms or limitations that would prevent you from performing the duties of your normal occupation.”

The decision was reached following a file review by a nurse case manager, which is the way Cigna commonly reviews claims.

Ms. S immediately began searching for legal representation and contacted us, Attorneys Dell & Schaefer, and we agreed to take on her case. After taking on the claim, we requested and reviewed the claim file containing all information submitted in support of Ms. S’s claim and all information relied upon by Cigna to deny the claim. It soon became apparent that Cigna did not properly evaluate the claim. Clear support from treating physicians had been ignored without a proper explanation.

According to Ms. S’s primary care physician, Ms. S could not return to work even if accommodations were made for her. She noted that Ms. S has Complex Regional Pain Syndrome (CRPS) that is exacerbated by stress and in turn, causes anxiety and depression. Yet, Cigna chose to ignore this credible doctor’s opinions and placed more weight on the review of their internal Nurse Case Manager who had never treated or examined Ms. S.

In addition to completely ignoring the opinions of the treating physicians it appeared that Cigna’s file reviewers did not fully understand the nature of Ms. S’s disabling condition. As an often misunderstood and misdiagnosed medical condition, CRPS/RDS is a difficult condition on which to base a disability claim. There is no specific diagnostic test to identify the condition and a treating doctor will diagnose this condition based on signs and symptoms.

This reality means CRPS/RDS claims are often denied, particularly by picky disability carriers like Cigna who scrutinizes claims and looks for very specific types of evidence to support a claim – or it often seems like they are looking for a lack of evidence to support a denial of benefits.

Such was the case for Ms. S. The appeal focused on making Cigna’s reviewers understand the condition afflicting Ms. S. The appeal also focused heavily on providing as much objective clinical evidence as possible so Cigna would have nothing left to argue apart from generating its own evidence that would support its decision to the deny the claim.

The appeal was successful. Within 60 days of receiving the appeal Cigna sent a letter to our office notifying us that Cigna was overturning the decision to deny benefits to Ms. S. While the Short Term Disability appeal was being reviewed, we also submitted a claim for Long Term Disability (LTD) benefits to Cigna. Not long after the appeal decision, our office also received correspondence indicating Ms. S would be paid Long Term Disability benefits as Cigna had found she met the criteria necessary to receive benefits under the LTD policy as well.

Unfortunately, as is the case with many CRPS patients, the condition can be chronic. Ms. S continues to suffer from her affliction but our office also continues to manage her disability claim against Cigna which is still being paid.

If you have a claim or potential claim with Cigna or any other carrier and you are suffering from Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy feel free to contact our office to discuss your options.

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, 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   *****

Terri E. (Maryland)

The process has been exactly how I had hoped it would be. Disability is a scary, unfriendly process, even for those of us who have worked in the claims administration area. It seems to be designed to deny benefits with complicated rules, burdensome documentation requirements, and constant requests for information to the beneficiary and my doctors. As a patient/beneficiary, you can feel like you are all alone and that you spend too much time jumping through hoops for the disability provider.

After a few months of doing it myself, I realized I wanted an advocate who could advocate for me with the provider and answer all of my questions on the Erisa process and rules. I interviewed one attorney in Maryland who was actually adversarial with me (his future client) so it was an awesome breath of fresh air when I interviewed Stephen Jessup. He was polite, extremely knowledgeable, upbeat, and calm! He helped me to understand the process and where I stood in it.

He and Vanessa communicate and keep me apprised of events within my case and make recommendations on actions I should take to proactively help my case win approval (e.g., Functional Capacity Evaluation). They are truly my safety net and well worth every penny because they help manage the disability provider and my doctors as well as ensuring I am on track in the process. I don’t think I would have survived this without them.

***** 5 stars based on 202 reviews

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