A Registered Respiratory Therapist was diagnosed with fibromyalgia and suffered from chronic pain with positive trigger points, fatigue, dizziness, and concentration and memory impairment. After it became clear that she could no longer perform the material duties of her own occupation as a Respiratory Therapist, she ceased work on November 6, 2015.
Despite overwhelming evidence supporting her claim for disability benefits, LINA (Cigna)* terminated her short term disability (“STD”) claim. Following the STD termination, she applied for long term disability (“LTD”) benefits, which were denied. Without the assistance of counsel, the Respiratory Therapist filed an appeal of her STD claim, believing that she was also appealing the denial of her LTD claim. However, LINA only reviewed her entitlement to STD benefits and upheld its prior decision. According to LINA, the LTD claim was never appealed.
In our experience, insurers rarely explain to the denied claimant the importance of the internal appeal that must be submitted following a denial or termination of disability insurance benefits. Luckily for the Respiratory Therapist, her disability insurance claim was governed by state law−not the ERISA regulations. Under state law and her LTD insurance policy, she was not required to exhaust her administrative remedies by filing an appeal of her LTD claim prior to filing a lawsuit. She also had the advantage of being able to submit additional evidence in support of her claims during litigation through the discovery process. If the ERISA regulations had applied to her claim, she would have been precluded from filing a lawsuit of the LTD claim as a result of her failure to appeal the adverse benefit determination and would not have been able to submit supplemental support of her claim after the appeals had been exhausted.
With the assistance of McDermott Law, LLC, the Respiratory Therapist filed a lawsuit to purse her claims for STD and LTD benefits. The parties eventually reached a mutually agreeable confidential settlement of her claims.
If you have questions about a denied disability claim or require assistance with your internal appeal or filing of a lawsuit, please contact the Denver Disability Attorneys at McDermott Law, LLC. Whether you are located in Colorado, the surrounding states or anywhere in the country, we likely can provide the specialized legal assistance you require.
*Although your letters are from “Cigna,” the actual long term disability coverage is underwritten by a subsidiary, Life Insurance Company of North America (LINA).