Cigna Reinstates Disability Benefits for an Accounting Manager

Our client, an accounting manager for twenty-three years, suffered a debilitating stroke that left the entire left side of his body paralyzed. Coupled with the affects of the stroke, he also suffered from severe discongenic disease. Unable to work, he applied for and received Social Security Disability benefits from the Social Security Administration (“SSA”) after meeting the SSA’s very strict definition of “disabled”. Shortly thereafter he applied for long-term disability benefits with his insurance carrier, CIGNA, under the terms of his employer’s disability policy and was subsequently awarded his disability benefits.

Two years after his award of long-term disability benefits, CIGNA informed him that his twenty-four month disability period for his “own occupation” was drawing near and further investigation would be conducted to determine his claim for further long-term disability benefits. Our client complied with all the requirements and requests from CIGNA in order to maintain his disability benefits, but to no avail, CIGNA denied further long-term disability benefits.

In their denial of benefits, CIGNA indicated to our client that he still had the use of his right upper and lower extremities and was thus able to perform the duties of his occupation. In response to the denial letter, we prepared an administrative appeal. In the appeal, we noted that CIGNA based its denial on a telephone conference, an alleged review with an in-house vocational expert, and a review with an in-house Nurse Case Manager; all of which were never disclosed to the insured or his counsel. Furthermore, we noted that CIGNA never spoke to our client before denying him his rightful benefits, nor did they consult with any medical specialist in the fields of medicine applicable to his conditions.

With the overweighing evidence in the appeal provided by us, and medical specialists, treating physicians, and vocational rehabilitation experts, CIGNA agreed to reinstate his long-term disability benefits and pay back benefits covering the period of time in which he was wrongfully denied.

Source: http://www.diattorney.com/resolved_cases.php?id=17

$1,200,000 Mental / Nervous Condition Settlement for a Practicing Attorney

Our client enjoyed a long and successful career as a partner in his personal injury law firm. As a young attorney, our client bought a private disability insurance contract that protected his income in the event of his total or partial disability. The contract defined total disability as the inability to perform the important duties of his occupation and partial disability as the inability to perform one or more of the duties of his occupation, while suffering aloss of at least 20%.

As a partner in the law firm, our client took initial calls, negotiated settlements with insurance adjusters, and marketed his practice with a monthly radio show. Unfortunately, at the age of 55 years old, our client developed severe depression. After taking some time off, our client returned to work at his law office in a limited capacity. He took initial calls and continued to conduct his monthly radio show. However, he no longer negotiated settlements with insurance companies.

His disability insurance carrier began paying partial disability insurance benefits. As his firm remained successful, there were many months in which our client did not receive his monthly benefit as he did not suffer a loss of at least 20%. Moreover, as his insurance carrier determined that he was partially rather than totally disabled, his carrier informed him that his benefits would cease upon turning 65 years of age, rather than providing lifetime benefits for a total disability.

After reviewing his policy we determined that under his definition of disability, he should have received total disability benefits from the beginning of his claim. We began pre-litigation negotiations and settled his claim for $1,200,000 plus an additional two months of total disability insurance benefits.

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