Cigna reinstates LTD claim after reviewing Dell Disability Lawyers appeal
Mr. M contacted our firm after receiving a letter from his disability insurer that he no longer qualified for disability benefits under his employer sponsored LTD plan. Cigna, also known as Life Insurance Company of North America (LINA), had paid disability benefits to Mr. M for two years due to his inability to work as a Process Operator for Formosa Plastics Corporation, USA. Mr. M suffers from a host of medical conditions including Chronic Pain Syndrome, various spine issues at all three levels, migraines, hypertension, as well as sleep disorders and gastro intestinal issues. During the first two years on claim Mr. M’s LTD policy required him to be unable to perform the material duties of his regular occupation as a Process Operator. However, like many group disability policies, the definition of disability changed in his policy after 24 months of benefits.
CIGNA’s Initial Decision to Deny LTD Benefits and the Decision to Contact Dell Disability Lawyers
After paying Mr. M benefits for 24 months, Cigna found that Mr. M was capable of performing an occupation at the sedentary exertion level. Cigna’s decision was based on a Peer review and Independent Medical Examination (IME). Based on these findings, Cigna found that Mr. M should be capable of performing certain sedentary occupations including that of a Maintenance Service Dispatcher or a Work Order Sorting Clerk. When Mr. M contacted our firm, he was also receiving social security disability benefits for the same disabling conditions. After speaking with us, we decided to take on the case and help Mr. M appeal Cigna’s decision to terminate Mr. M’s claim.
Appeal of CIGNA’s Denial
After receiving a copy of the claim file from Cigna, our team reviewed the IME report and Peer Review Report on which Cigna relied and a plan of action was set in motion. It soon became apparent that Cigna’s Peer Review was insufficient to support the conclusions reached in the Peer Review Report.
The Peer Review had been performed by Cigna’s hired medical consultant, Dr. Jaime Lewis. Upon reviewing Mr. M’s medical records, Dr. Lewis acknowledged that the records indicated physical dysfunction but concluded that Mr. M could lift, carry, push and pull 20 pounds occasionally. He could allegedly sit 60 minutes continually up to 8 hours per day with the ability to alter standing and walking as needed. He could allegedly stand and walk 10-15 minutes at a time up to 3 hours a day. He could allegedly reach overhead and below waist occasionally. He could allegedly reach at desk level, handle, finger, feel, and simple grasp unrestricted.”
Based on the above restrictions, Cigna determined that Mr. M was capable of performing at the Sedentary level of functioning. Interestingly, Dr. Lewis specifically stated that it is unlikely that that Mr. M would have the ability to return to full-time employment without restrictions given his history of cervical fusion.
In support of Mr. M’s appeal, Dell Disability Lawyers obtained custom questionnaires from Mr. M’s treating physicians specifically addressing the gaps in Mr. M’s medical records as well as the issues in Cigna’s review. Ms. M’s treating physicians provided detailed explanations corroborating Mr. M’s disability.
Cigna and its Peer Reviewer had overlooked or ignored the fact that the most recent medical records showed that Mr. M’s disability had progressed for the worse in his upper extremities and that his condition would preclude him from working any type of sedentary job. The evidence clearly indicated that Mr. M’s functioning in his cervical spine has continually deteriorated.
In addition to the Peer Review Report, Cigna relied on an old IME report it had performed months before the 24-month mark which concluded that Mr. M could perform sedentary work. However, the IME report documented a less than thorough evaluation.
Dell Disability Lawyers argued that if Cigna had been interested in obtaining the most accurate assessment of Mr. M’s true functional limitations then a Functional Capacity Evaluation (“FCE”) would have been requested. But Rather than requesting a functional capacity evaluation, Cigna chose to rely on a peer review and independent medical evaluation to determine Mr. M’s functional limitations.
Since Cigna did not request one and to provide more objective evidence of Mr. M’s functional limitations, Dell Disability Lawyers had Mr. M undergo an independent FCE to provide additional support for Mr. M’s claim. The results of the FCE confirmed that Mr. M has a less than sedentary level of work ability. The FCE report along with custom questionnaires from treating physicians and a thorough outline of the objective or clinical evidence corroborating Mr. M’s disability claim were submitted to Cigna in support of the appeal.
CIGNA Reinstates the LTD Claim
After reviewing the appeal submitted on Mr. M’s behalf Cigna had no choice but to reinstate Mr. M’s LTD claim. Our office was notified by phone that Mr. M’s LTD claim had been reopened and all back benefits due to Mr. M would be paid.
Dell Disability Lawyers continues to manage Mr. M’s claim with Cigna to ensure Mr. M has the best chances of staying on claim for as long as he remains disabled under the terms of his disability plan.
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Answered Questions by Our Lawyers
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Showing 8 of 48 Answered Questions
Q: I filed an appeal and lost. Is it worth pursuing?
A: Kim, in my opinion, yes. If you are still within your timeframe to file a lawsuit you have little to lose in t... Read More >
Q: Do I have a case for STD? I was denied twice because a) I hadn't been a fulltime employee for 6 months and b) I had ben on FMLA since Febury.
A: Frank, we would need to see a copy of the denial letter and the policy. Please feel free to contact our office... Read More >
Q: How can I appeal Cigna's decision if there are no written communications explanation the reasons for claim termination?
A: Tret, Cigna will be required by law to provide you with a written denial letter setting forth its reason for t... Read More >
Q: Is there a process for appeals not being responded to in the time given? Also, how do I access my records?
A: SB, ERISA provides 45 days to render a decision on appeal with the possibility of a 45 day extension- basicall... Read More >
Q: Is it worth is to go to court over $2500?
A: Mark, If you have no additional appeals your only option would be to find representation to file a federal law... Read More >
Q: How long will it take Cigna to get back to me? Will my military retiree pay be held against my policy 60%? Will Cigna exploit the disparity in the medical community over my illness?
A: Craig, Unfortunately it can sometime take up to 45 days to receive a decision from Cigna as to your entitlemen... Read More >
Q: Do I have any options to void an agreement I signed? Can Signa offset my SSDI benefits?
A: Donna, I do not know if you would have any avenues to void the agreement you signed. Regardless of agreeing th... Read More >
Q: Can I sue Cigna even if they do end up paying me?
A: Linda, If your policy is governed by ERISA you will need to go through the administrative appeal process prior... Read More >
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Disability Lawsuit Stories
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Get Your Disability Application Approved
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
Sue Your Disability Company
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Prevent A Disability Benefit Denial
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
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Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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 insurance 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 phone, email, fax, or video conferencing sessions. 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 insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.