A former Cybersecurity Specialist (Ms. N) was rendered disabled as a result of a rare condition known as arachnoiditis, which causes neurological deficits and severe chronic neuropathic pain. Ms. N. excelled at her career and loved working but, unfortunately, the severe pain in her hips, buttocks, legs, and lower back made it impossible for her to work in her occupation. After paying short term disability (STD) benefits for several weeks, Cigna Group terminated her STD benefits, based on the opinion of a Nurse Case Manager, who had never seen or spoke with Ms. N.
The disability attorneys and paralegals of McDermott Law, LLC assisted Ms. N. in submitting an appeal of Cigna’s adverse benefit determination. At the same time, we submitted Ms. N’s LTD claim, also with Cigna. The comprehensive appeal and LTD submission provided significant evidence demonstrating Ms. N’s disability, including a Functional Capacity Evaluation, medical records, a letter from Ms. N’s pain management physician, and letters of support from her friends and family. The appeal letter also provided several arguments explaining why Cigna’s termination of benefits was arbitrary, capricious, and not supported by the evidence. After reviewing the appeal, Cigna overturned its decision and approved the remainder of Ms. N’s LTD claim.
During Cigna’s review of the LTD claim, it insisted on the need to send Ms. N for an Independent Medical Examination (IME). Our office corresponded repeatedly with Cigna, agreeing to allow the IME, but only under certain conditions. Among our requests, we asked for the opportunity to be involved in determining which physician would perform the IME. We also asked that Cigna allow Ms. N to videotape the IME to ensure the provider was report accurately represented the evaluation. Cigna ignored our requests but our office persisted and would not allow our client to be subjected to a needless evaluation without certain conditions being met. Ultimately, Cigna determined the medical evidence it had on file sufficed to approve Ms. N’s LTD claim without the need for an IME.
If you have experienced similar claims handling tactics, contact McDermott Law, LLC for experienced assistance in overcoming an improper termination of your benefits.