Waiver of Premium Benefits Unfairly Denied
Waiver of premium benefits were unfairly denied by Cigna in a recent court case. The claimant, Mr. Macnally worked as a CEO before he became disabled. His diagnosis of multiple sclerosis caused him to stop working.
Cigna awarded Mr. MacNally both long-term disability (“LTD”) benefits and waiver of premium benefits (“WOP”). Like LTD benefits, WOP benefits are awarded upon a finding of disability and result in the waiver of premiums for life insurance coverage.
Mr. MacNally received WOP benefits for over 3 years for his multiple sclerosis. After 3 years, Cigna terminated his WOP benefits. They based the termination on a physical abilities assessment form (“PAA”). His physician, Dr. Allen Ingenito, filled out the form.
From these restrictions, Cigna found that he could perform in two separate jobs. During the entire claims process Cigna had their own doctor review the medical records. Their doctor found that he was not disabled.
Mr. MacNally appealed Cigna’s decision. He gave them additional medical records in support of his disability. Included were records and letters from Dr. Ingenito. The letters confirmed Mr. MacNally was disabled. He could not work in any occupation. Dr. Ingenito even criticized Cigna’s doctor’s opinion. Still, Cigna continued to deny his WOP benefits.
The court found in favor of Mr. MacNally for two reasons:
- The court ruled that Mr. MacNally was unable to work in any job.
- The court found Cigna acted with bias. It stated that Cigna’s doctor was not qualified. They were wrong in relying on his opinion.
The court stated that Cigna used the PAA as a “lottery ticket.” The court held that Cigna ignored the medical evidence showing Mr. MacNally was disabled. This included Dr. Ingenito’s letters. Instead, Cigna looked for any piece of evidence that supported its goal of denying WOP benefits.
The experienced lawyers at Dabdoub Law Firm know how Cigna handles its claims. We can easily identify when Cigna is treating a piece of evidence as a lottery ticket for a denial.