Reversal of Cigna STD and LTD Denials: Professional recruiter with post traumatic stress, disorder, depression and anxiety

Posted on Wednesday, October 16th, 2019 at 3:46 pm    

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

Claimant’s Occupation: Personnel recruiter

Our Representation: Supplement pending short term disability appeal in response to unfavorable medical decisions and file long term disability application.

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

Synopsis: Claimant was forced to stop working as a personnel recruiter for a prominent institution due to severe mental, behavioral and emotional impairments. She was the victim of an attack and suffers from affective disorders including post traumatic stress disorder, anxiety, and depression. Cigna initially approved claimant’s short term disability benefits based on her inability to perform the material duties of a professional-level personnel recruiter. Without any change in the medical evidence, Cigna terminated benefits just a few weeks prior to her transition to long term disability benefits alleging that the medical evidence no longer supported disability under the STD policy.

The disabled claimant appealed on her own and was unsuccessful. She then filed her own voluntary appeal and was repeatedly being asked by Cigna to respond to adverse medical review opinions by clinicians who never examined her in person. Cigna also continued to challenge the adequacy of the claimant’s medical treatment despite the first availability of a new specialist being months in to the future.

Sensing another denial of benefits, she retained our law firm on a contingent fee basis. We obtained an extension of time from Cigna to submit additional evidence for the insurance company’s consideration during the pending appeal process. We also started the client’s long term disability application while working to obtain supportive evidence. Cigna quickly denied the long term disability application.

Our law firm obtained and submitted additional medical evidence further establishing our client’s disability under both policies and advocated for our client to influence changes in the appeal process that resulted in a favorable outcome. Despite being faced with multiple medical reviews alleging our client was not disabled, and based on the evidence and arguments presented by our law firm, Cigna reversed course and recognized our client’s disability under the short term disability and long term disability policies. In doing so, our law firm protected our client’s best interests and maximized her recovery of benefits under both the STD and LTD policies.

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 reversed its denial of LTD benefits, (3) Cigna paid past-due LTD benefits, and (4) Cigna reinstated monthly long term disability benefit payments.

Take-aways:

  1. 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.
  1. 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.
  1. The appeal process may be (and often is) your only chance to submit evidence supporting disability to the insurance company. If you do not hire an attorney for help during the appeal process, you may lose your ability to have an experience disability insurance attorney protect your best interests and the value of your claim.
  1. While difficult, the appeal process can prove successful. Having experienced representation from a disability attorney can sometimes make all the difference.

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 (267) 419-7888.

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.

We’ve fought the big insurance companies.
Call, chat, or email us today to get started.