Our Cigna Long Term Disability Lawyers Represent Disabled Individuals Nationwide
Cigna Group Insurance company insures and administers many, many group short term disability and group long term disability policies across the country. These group policies are often underwritten by the Life Insurance Company of North America, or LINA. LINA’s principal place of business is in Philadelphia, Pennsylvania. Because Cigna’s disability underwriter is quite literally in our law firm’s backyard, we can handle most every Cigna disability claim across the country during the administrative appeals process and in federal court litigation. While we represent the disabled against many insurance companies, the majority of our law firm’s clients have disability claims pending with Cigna. Our law firm is uniquely qualified to handle Cigna long term disability claims due to our wealth of experience in handling Cigna appeals and lawsuits.
The Success of Our Cigna Long Term Disability Insurance Lawyers
Our law firm is proud of our success rate on appeal when handling Cigna long term disability matters. Reversing Cigna’s denial or termination of group long term disability benefits is extremely challenging, but our experienced disability insurance attorneys have the legal experience and know-how to develop appeals which maximize our clients’ chances to be paid long term disability benefits without a court battle. While no law firm or attorney can guarantee success in any particular matter, more often than not our law firm is able to develop comprehensive Cigna long term disability appeals that reverse a denial or termination of benefits, avoiding a lawsuit in federal court.
The Most Common Grounds Used to Deny or Terminate a Cigna Long Term Disability Claim
Cigna routinely uses several rationales for denying or terminating a group long term disability benefit claim. Here are a few:
A lack of objective evidence, or a lack of “measurable” clinical findings, to prove Disability.
By our estimate, the most common reason Cigna denies or terminates a long term disability claim is due to a lack of objective medical evidence. First, it is important to understand what Cigna is talking about. Objective medical evidence can be diagnostic testing such as MRIs, CT scans, xrays, nerve conduction testing, lab testing (such as blood work), pulmonary function testing, etc… Objective medical evidence can also be a physician’s written clinical observations and physical examination findings as documented in your treatment notes. Most long term disability policies do not require “objective medical evidence” to prove Disability, but Cigna almost always requires such evidence as proof of Disability.
Cigna’s requirement of “objective evidence,” despite its absence in the actual language of the LTD policy, can be very problematic for a few reasons. Abnormal diagnostic testing may show anatomical or organic abnormalities, but it does not evidence pain. It is possible for someone to experience severe pain with only minimal or moderate abnormal findings, and it is also possible for someone with severely abnormal findings to experience minimal pain. In short, only you know the true impact of your impairments and Cigna’s requirement for “objective evidence,” while it might sound reasonable, is merely a ruse by which the insurance company’s doctors subjectively determine the weight or importance of that evidence. Insurance companies such as Cigna will routinely “cherry pick” the medical evidence, minimizing the abnormal evidence and focusing on evidence which does not exist. Another problem is that some medical diagnoses such as fibromyalgia, complex regional pain syndrome, and small fiber neuropathy can evade abnormal results on common forms of medical testing. This can make it medically impossible to provide “objective evidence” of one’s disability.
When Cigna denies or terminates long term disability benefits it is most often based on the subjective opinion of the insurance company’s non-examining nurse or doctor sitting in an office hundreds of miles away from where you live. These internal “Nurse Case Managers” or “Medical Directors” and external “physician peer reviewers” provide a medical opinion often based on incomplete information, and almost always without the benefit of conducting an in-person examination. This medical review practice is commonplace and can lead to wrong and unreasonable claim determinations that by law Cigna is not allowed to make.
Our law firm is very experienced in combating Cigna’s long term disability benefits decisions where it alleges a lack of objective medical evidence sufficient to prove your Disability.
The individual is capable of performing “any occupation” and qualifies for such occupations based on his or her education, training or experience.
For those individuals lucky enough to survive the “Regular Occupation” period of Disability (i.e. be paid the first 24 months of benefits), many individuals’ long term disability benefits are terminated by Cigna when the definition of Disability transitions to “any occupation.” Most group long term disability insurance policies contain provisions like this one,
After Disability Benefits have been payable for 24 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is:
- unable to perform each and every material duty of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and
- unable to earn 80% of more of his or her Indexed Earnings.
Typically you will receive a letter quoting the above around the 18th month Cigna has paid long term disability benefits, explaining that Cigna has “…begun a review to determine if your client will remain eligible for benefits” beyond the any occupation transition date.
If your pre-disability occupation was a job that required travel, lifting over 10 pounds, or a good amount of standing or walking, this “any occupation” review puts the continuation of your long term disability benefits at great risk. Cigna will often allege that you possess the “education, training or experience” to qualify for a less physically demanding occupation, such as a sedentary job (i.e. a desk job). For example, Cigna will often allege that while a Registered Nurse cannot perform the strenuous physical demands of his or her occupation, he or she can perform desk jobs and does possess the education, training, and experience necessary to qualify those jobs, such as a Cardiac Monitor Technician, a Coordinator of Volunteer Services, or a Telephonic Triage Nurse.
Cigna’s long term disability decisions regarding the claimant’s work capacity and vocational qualifications are often both wrong and unreasonable. Our law office has a wealth of experience in fighting Cigna’s long term disability terminations resulting from an any occupation review.
The pre-existing condition exclusion precludes payment of long term disability benefits.
It is also common for Cigna to deny long term disability benefits alleging that the policy’s pre-existing condition exclusion applies; thus, no benefits are payable. Most group long term disability policies contain pre-existing condition language that prevents a claimant from being paid disability benefits if (1) the person stops working within a year of the effective date of the long term disability policy, and (2) the person received medical treatment of any kind for the now disabling impairment in the few months prior to the effective date of the long term disability policy.
Pre-existing condition provisions in disability insurance policies are legal. There is a common misconception that the Affordable Health Care Act (ACA, or “Obamacare”) made such provisions illegal in disability insurance policies, but ACA only applies to health insurance, not disability insurance policies.
But just because the pre-existing condition exclusion may be legal, that does not mean that Cigna applied the policy language correctly in determining whether or not your benefits are payable. If your group LTD claim was denied based on Cigna’s allegation that your Disability is due to a pre-existing condition, you should consult one of our law firm’s experience Cigna long term disability lawyers immediately.