Approval of Cigna STD and LTD Claims Following Termination of STD Benefits: Professional project manager unable to continue working due to cognitive impairment

Posted on Wednesday, May 27th, 2020 at 6:17 pm    

Insurance Company: Cigna, underwritten by Life Insurance Company of North America

Claimant’s Occupation: Professional project manager

Our Representation: Respond to termination of terminated short term disability claim and seek approval of long term disability application.

Result: Short term disability termination overturned, Long term disability application approved, both disability claims approved

Synopsis: Claimant was forced to stop working in her professional occupation as a project manager due to cognitive deficits resulting from brain surgery. Despite clearly abnormal neuropsychological testing, Cigna terminated short term disability benefits just prior to he claimant’s transition to long term disability coverage alleging that she was was no longer disabled. She retained our law firm on a contingent fee basis to appeal the termination of short term disability benefits and seek approval of her long term disability claim. Our law firm worked to submit detailed medical opinions from our client’s treating providers as well as additional and updated medical records. The totality of the medical evidence compiled and present by Abell and Capitan Law supported our client’s disability under both policies. The best possible result was obtained for our client in this particular matter.

As a result of our experienced legal representation, (1) Cigna reversed its termination of short term disability benefits, (2) Cigna paid past-due STD benefits, (3) Cigna approved our clients long term disability claim despite the termination of her STD claim a few months prior, (3) Cigna paid past-due LTD benefits, and (4) Cigna reinstated monthly long term disability benefit payments.

Take-aways:

  • Disability insurers will mistakenly terminate benefits without advance notice and without substantial changes in the disabled individual’s medical condition. However, this does not mean that benefits can be easily reinstated. Rather, we find that once a single medical reviewer alleges that the individual is not disabled, this conclusion can erroneously echo throughout the remainder of the claim process by the other medical reviewers that follow unless experienced legal representation is obtained to help maximize the disabled claimant’s chances of success.
  • Very accomplished professionals who are well educated, have wonderful work histories, and the support of their doctors still require legal representation when facing an administrative and legal process that can be confusing and daunting to navigate alone.
  • Working to get a long term disability claim approved, a claim that has much more financial liability to the insurance company by comparison to STD coverage that usually only lasts 3 to 6 months, is very difficult but can be accomplished with the help of experienced legal representation.

Can we help you? Abell and Capitan Law handles disability insurance claims nationwide. We have a great deal of experience handling physical, cognitive, and mental health impairment cases with a multitude of insurance companies, including Cigna (Life Insurance Company of North America) mentioned in the case study above. We offer free legal representations. If you have questions, or if we can possibly be of service to you, please complete the form on this page or please call us at (866) 635-0824.

Disclaimer: The results discussed in this case study are not a guarantee of success. Any case studies, testimonials, examples, and illustrations cannot guarantee that current or potential client of Abell and Capitan Law will achieve similar results. Claim results and legal outcomes may vary significantly based on the factors related to a particular client’s medical impairments, related evidence, the unique disability policy at issue, and a host of other variables and factors.

Written by : Erik Abell & Joe Capitan

Last Updated: December 13, 2021
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