A former Component Environmental Test Engineer suffering from cardiomyopathy with advanced systolic heart failure filed a claim for long-term disability benefits with Cigna Group Insurance (“Cigna”)/Life Insurance Company of North America (“LINA”). His claim was initially denied, then overturned after reviewing an appeal filed by the Engineer.
Cigna paid benefits during the 24-month “Regular Occupation” definition of disability, then terminated his claim in the “any occupation” stage of the claim.
The termination was based on restrictions and limitations conjured up by Cigna’s reviewing physician and on occupations identified by Cigna’s vocational counselor. When the Engineer pointed out the fact that he would have to obtain a new degree in order to perform the identified occupations, Cigna’s claims handler told him he would just have to go back to school.
The Engineer again filed his own appeal of the termination but was unsuccessful this time in obtaining his benefits. He then retained McDermott Law, LLC to assist him with the second, voluntary appeal offered under his policy. The comprehensive appeal provided significant evidence of the disabling nature of the Engineer’s terminal medical condition. It described the wrongfulness of Cigna’s reliance upon physician reviewers who lacked the experience and training to objectively and competently render decisions with regard to his medical conditions and inability to work. It also illustrated that Cigna’s reliance on the Transferable Skills Analysis translated into an attempt to redefine the definition of disability by suggesting the Engineer acquire additional education, training and experience to perform one of the occupations identified therein.
After reviewing the extensive appeal, Cigna approved the Engineer’s claim. If you have experienced similar claims handling tactics, contact an experienced Denver disability attorney McDermott Law, LLC for experienced assistance in overcoming an improper termination of your benefits.
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