Cigna denies disability benefits to former Healthsouth Corporation nurse after paying for 11 years
Disability Lawyer Sues Cigna For Denying Long Term Disability Benefits After Paying for 11 Years
In Susan Sheehan Vs Cigna Group, Life Insurance Company of North America, a disability attorney filed a lawsuit at the District Court District Of Massachusetts claiming that the giant disability insurance company Cigna Group (Cigna), had contravened the provisions of the Employment Retirement Income Security Act (ERISA) in its handling of a client’s claim for disability benefits.
The Nature of the Lawsuit against Cigna
The plaintiff Susan Sheehan was a nurse at the St. Joseph’s Hospital in Lowell, a facility acquired by the Healthsouth Corporation. She participated in a long term disability plan (LTD) that was maintained by the Healthsouth Corporation. The Plan was underwritten by the Life Insurance Company of North America which is a subsidiary of Cigna.
Prior to the plaintiff’s LTD benefits being terminated by Cigna, she had a history of suffering from multiple unruptured intercranial aneurysms. Between 1996 and 1997, the plaintiff had undergone no less that three craniotomies/clippings and two EG coilings. She has twelve identified unruptured intercranial aneurisms, eight of which have been repaired to date. As a result of her disabling medical condition, the plaintiff stopped working on September 24th 1997. Since March 1998, the plaintiff has been receiving LTD benefits.
Termination of Long Term Disability Benefits by Cigna After Paying for 11 years
On November 22nd 2009, the plaintiff was informed by Cigna that it was terminating the plaintiff’s LTD benefits on December 18th 2009. Cigna contended that the plaintiff was able to work full time sedentary and light occupations despite her current disabling status.
The Appeals to Cigna’s Decision to Terminate LTD Benefits
In light of Cigna’s decision to terminate the plaintiff’s LTD benefits, the plaintiff appealed that decision on May 10th 2010. Additional medical and vocational documentations were submitted to support the plaintiff’s appeal. Nevertheless, Cigna continued to specify that the plaintiff could perform certain occupation and denied her appeal on July 22nd 2010.
On January 11th 2011, the plaintiff made a second appeal to Cigna’s decision to terminate her LTD benefits. She enclosed a functional capacity assessment and additional medical and vocational information for her second appeal. This second appeal was also denied by Cigna on April 6th 2011. This denial also represented Cigna’s final determination of the plaintiff’s claim for LTD benefits and hence exhausted all her administrative remedies.
The Cause for Legal Action Against Cigna
The plaintiff argued that Cigna’s final denial failed to expressly address the information the Plaintiff provided in her January 11th 2011 appeal. The plaintiff had been approved for Social Security Disability benefits and is still receiving those benefits. She argued that Cigna’s decision
- Was arbitrary and capricious.
- Was not supported by a good faith evaluation of the evidence.
- Is contrary to law.
The plaintiff alleged that this due to the following actions on Cigna’s part:
- Cigna failed to give appropriate attention to testimonies and clinical documentations of the plaintiff’s disabling medical signs and symptoms by the plaintiff’s attending physicians.
- Cigna failed to give appropriate weight to the evidence of the plaintiff’s capacity to perform her job, in light of her persistent headaches, pain, loss of balance, visual disturbances, urinary frequency and incontinence, diminished energy levels, and loss of capacity to sustain her efforts.
- Cigna completely ignored the plaintiff’s non-exertional impairments, aside from her cognitive status, in evaluating her claim.
- Cigna failed to consider the combined effect of all of the plaintiff’s difficulties that arose from her past brain surgeries.
- Cigna failed to (at least expressly) consider the results of the functional capacity testing and the vocational assessments which the plaintiff submitted but instead insisted that she was able to perform work for which she was not suited.
Relief Sought by the Plaintiff
As a result of Cigna’s actions, the plaintiff requests the Court for the following relief:
- Assume jurisdiction of the plaintiff’s case
- Declared that Cigna has violated the relevant provisions of the ERISA by its actions in denying the plaintiff the benefits she is legally entitled to receive.
- Or alternatively remand the case for further proceedings to consider and address all of the medical evidence presented by the plaintiff.
- An award of attorney’s fees
- An award of other such relief that the Court finds just and proper.
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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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