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Cigna Once Again Reverses Its Decision to Terminate Benefits of Client Suffering from Multiple Sclerosis

March 9, 2017

Cigna Reverses Decision to Terminate Benefits for Woman with MS

Cigna Reverses Decision to Terminate Benefits for Woman with MS

McDermott Law has once again been successful on behalf of a client whose disability benefits were wrongfully terminated . . . TWICE.  Ms. J had been receiving disability benefits as a result of suffering from Multiple Sclerosis (MS) when Cigna terminated her benefits claiming she no longer met the definition of disability.   She hired our office to assist her with the required internal appeal (required because her disability benefit was employer-provided and thus governed by the ERISA laws).

In its investigation of her claim, Cigna relied on an evaluation completed by its own “Associate Medical Director.”  The appeal we submitted emphasized the fact that Cigna did not take into consideration the opinions of Ms. J’s primary care physicians, with no explanation as to why and, instead, relied solely on the opinions of its in house medical director who had never seen or treated Ms. J and whose opinion was seriously flawed.  We also we provided evidence proving that Cigna’s denial was based on incomplete evidence and a misunderstanding of Ms. J’s medical conditions.

In rendering its decision on the internal appeal, Cigna agreed our client was, in fact, “disabled” according to the terms of the long-term disability insurance policy and reinstated disability benefits.  However, Cigna began reviewing Ms. J’s claim under the “any occupation” provision of the Policy and determined she could somehow return to work despite her severe pain and fatigue caused by her MS and once again terminated benefits.

With our assistance, Ms. J submitted a second appeal of this adverse determination, working with her treatment providers to obtain detailed opinions about her conditions and their patient’s disabling health problems.  Our law office ultimately submitted a second appeal of the long term disability claim denial to Cigna, as required by the policy of insurance and ERISA statutory and regulatory procedures.  The appeal addressed the report written by another of Cigna’s in house physicians who had (erroneously) reviewed the claim.  It was not surprising that Cigna’s in-house physician concluded that she was not disabled even though this physician had never met or spoken with the claimant.  We addressed the errors in the reviewing physician’s reports and provided even more evidence to support our client’s inability to work.

Because of the efforts undertaken by our office, in conjunction with our extensive experience in handling these types of claims, Cigna again agreed with our position and reinstated Ms. J’s LTD benefits.  Our ERISA appeal succeeded in convincing Cigna to overturn its prior denial of the claim.  Our client suffering from multiple sclerosis is now being paid the benefits that should never have been terminated.

If your ERISA disability benefits have been wrongfully terminated or denied, contact a Denver disability lawyer at McDermott Law for experience in standing up to insurers and help securing the benefits you likely deserve. Call (303) 964-1800 or email us using the contact form on this page to find out more about how we can help you.

From offices based in Denver, we provide the highest quality legal services to disabled people throughout the state of Colorado, the surrounding states and nationwide.

Categories: Appeals, Denial of Benefits, Disability, ERISA Claims, Long-Term Disability Benefits

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