Our client was a former Registered Nurse (RN) who was forced to stop working and file a disability claim with CIGNA due to chronic pain. Chronic pain is a common symptom that may be caused by one or more of many disabling medical conditions. Because pain is difficult to objectively measure, many symptoms are described by a patient to his or her doctor. Our client suffered from rheumatoid arthritis, cervical radiculopathy and chronic pain, among other conditions.
CIGNA approved the long-term disability claim for two years before terminating benefits. Of note, the Social Security Administration approved her disability claim at the initial level.
In our client’s case, the long-term disability policy’s definition of disability changed after 24 month from her own occupation to any occupation. This means that CIGNA would pay benefits during the own occupation period if she was unable to work as an RN. During the any occupation period she had to be unable to work in any occupation she was reasonably capable of doing based in her education, training and experience.
CIGNA based its termination of benefits on paper-based reviews conducted by its paid doctors. It also used a social media investigation and video surveillance to support its decision. CIGNA claimed our client could do more than she said she could. Our client appealed CIGNA’s termination on her own without seeking an attorney. This appeal was rejected. Our firm chose to file a second, voluntary appeal with CIGNA to make all important medical evidence was in CIGNA’s claim file.
The second appeal included updated medical records, our customized forms completed by our client’s doctors, and a dispute of the paper reviews. We also pushed back on the accusations by CIGNA based on surveillance and the social media investigation. CIGNA reversed its decision and reinstated disability benefits back to the date when they were terminated.
How We Can Help
Our long-term disability attorneys are familiar with the tactics disability insurance companies like CIGNA use to terminate benefits. We represent clients nationwide. Contact us today for your initial case evaluation.
To learn more about chronic pain, go to the following resources:
- American Chronic Pain Association