McDermott Law has once again been successful on behalf of a client whose disability benefits were wrongfully terminated. These long-term disability benefits governed by the Employee Retirement Income Security Act (ERISA), and insured by CIGNA, have now been granted. Mr. T suffered from several conditions, including a fractured Tibia/Fibula for which he required extensive surgery, Bilateral Carpal Tunnel Syndrome, Lumbar Strain, Lumbar Spondylosis, Cervical Cord Compression and Disk Herniation. Mr. T originally filed a claim for long-term disability (LTD) benefits, which was approved, and shortly thereafter, terminated without an improvement in his conditions.
CIGNA relied on an evaluation completed by its “medical department” when denying Mr. T’s LTD benefits. It used language we routinely see in CIGNA denial letters. Specifically, it faulted Mr. T’s medical records with not including objective exam findings that demonstrate how his conditions would impair his ability to carry out his occupational skills. Our office has seen this exact same language in many other CIGNA denials. Our appeal emphasized the fact that CIGNA did not take into consideration the opinions of Mr. T’s primary care physician with no explanation as to why and, instead, relied solely on the opinions of its reviewing physician reports from doctors who had never seen or treated Mr. T and whose opinions were flawed. Lastly, we provided evidence and argument proving that CIGNA’s denial was based on incomplete evidence and a misunderstanding of Mr. T’s medical conditions.