Cigna Denies Disability Benefits, But Additional Information Could Have Resulted In A Victory
When filing a disability application or appeal it is of the utmost importance to provide the insurance company all of the relevant medical records and/or documentation supporting your disability in a timely manner.
If you fail to submit any important documents or records they will not be considered by the judge at a later date if your disability claim is denied.
This is why it is very important to have a disability lawyer guide you through the appeals process in order to determine what documentation must be submitted to ensure the administrative record is complete. You only get once chance to submit a good appeal.
Illustrating this very situation is a recent decision by The United States District Court for the Eastern District of Louisiana, where the judge ruled in favor of Life Insurance Company of North America’s (LINA) Motion for Summary Judgment.
In that case, the Plaintiff was involved in a work-related car accident injuring his neck and back. He attempted to return to work, however the pain was too great and his physicians agreed he should apply for long-term disability benefits. LINA reviewed the Plaintiff’s application for benefits as well as his medical documentation and denied his claim stating that he “lacked positive clinical measurements to support a degree of functional impairment that would prevent him from returning to work in his regular occupation.”
After his claim was denied, the Plaintiff applied to the Social Security Administration (SSA) for disability benefits with the help of his Louisiana disability attorney. Around the same time, the Plaintiff notified CIGNA that he wished to appeal their decision and submitted additional documentation in support of his disability, however, neither Plaintiff or his attorney ever informed Cigna of the pending SSA benefits application or the later decision by the SSA to approve his disability benefits.
Cigna denied Plaintiff’s ERISA appeal due to the lack of objective medical evidence and did not consider the SSA decision as they were never made aware of it. The Plaintiff declined LINA’s offer to file a voluntary administrative appeal and instead filed and ERISA lawsuit. Realizing that he had neglected to provide LINA with the SSA decision, the Plaintiff submitted the SSA decision as a part of his trial exhibit list.
The district court ruled that the SSA decision was not part of the administrative record and could not be considered.
Louisiana Federal Judge Agrees with the Cigna Denial of Disability Benefits
The court of appeals affirmed the lower court’s decision stating that: “The administrative record consists of relevant information made available to the administrator prior to the Complainant’s filing of a lawsuit and in a manner that gives the administrator a fair opportunity to consider it.” The Plaintiff had ample opportunity to supplement the administrative record with the SSA’s decision as he filed the lawsuit nearly 18 months later. Failing to provide this information to LINA before filing the lawsuit was inexcusable and therefore, the Court agreed that the SSA’s decision was not part of the administrative record and denied Plaintiff’s request to remand his case back to CIGNA for further review.
Lesson to Be Learned from this Cigna Disability Denial Lawsuit
The important lesson that can be taken from this case is that any pertinent information a claimant would like a judge to consider in any future case against their insurance company for disability benefits MUST be submitted in a timely manner before his or her administrative record is closed.
Disability cases can involve thousands of pages of medical records and other pertinent documents. All of the documents need to be carefully reviewed to determine which documents are relevant and which are not. Once the administrative record is closed, and a disability denial lawsuit is filed, no additional information can be considered.
This is why it is extremely important to hire effective counsel to represent you who specialize in disability income claims to ensure that your administrative record is complete and that you do not end up in the same predicament as the Plaintiff described above.
Contact us for a free consultation to discuss your disability claim, denial, appeal, or lawsuit.
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Answered Questions by Our Lawyers
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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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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.
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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.
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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.
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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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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.