Background
Before his disability, Barry Batchelor was working as a drilling engineer for BP America. He was a BP employee from 1999 to 2000 in various capacities. Mr. Batchelor first began experiencing muscle and joint pain in 2001, but it subsided due to several ergonomic adjustments. In 2007, however, his pain returned. Despite several months of physical therapy, his condition worsened. He was eventually diagnosed with chronic fatigue syndrome, fibromyalgia, Lyme disease, and myofascial pain. As a result of his symptoms, Mr. Batchelor stopped working in June of 2009.
The Claim
Although Mr. Batchelor’s short-term disability claim was paid in full, Cigna denied his long-term disability claim. Cigna’s basis for denying benefits was that there was not sufficient evidence of disability, including clinically measurable testing. Mr. Batchelor appealed, providing a Functional Capacity Evaluation (FCE) supporting disability. Cigna requested a second FCE, which also supported disability. During this time, the Social Security Administration approved Mr. Batchelor’s disability benefits.
Cigna also performed a Transferable Skills Assessment (“TSA”) and found that although Mr. Batchelor could perform other occupations, none met the income requirement under the disability insurance contract. Cigna paid the long-term disability claim and informed Mr. Batchelor that he was disabled not just from his own occupation, but also any occupation.
Cigna paid long-term disability benefits from 2009 through 2016. Benefits were terminated based on an in-person examination by Cigna’s hired doctor, a second TSA, and surveillance footage. Mr. Batchelor appealed twice, providing additional medical evidence to support his disability. Cigna denied both appeals, using paper-based reviews by its paid doctors as the reason for its decisions.
The Lawsuit
Because the parties agreed that Cigna’s long-term disability insurance contract did not confer discretion, the court reviewed Mr. Batchelor’s case de novo. The court found that the opinions of Mr. Batcherlor’s treating physicians were more credible and reliable than Cigna’s physician reviewers. The court reasoned that treating providers had more information upon which to make conclusions about Mr. Batchelor’s inability to return to the workforce. Moreover, the court found that the video footage Cigna obtained of Mr. Batchelor did not contradict his diagnoses, symptoms, or physical abilities. The court found that the medical evidence supported that Mr. Batchelor could not work in any occupation, as defined by the disability insurance policy.
Lawyers Specializing in Disability Insurance Claims
Because disability insurance law is complicated, it is important to get legal help from a lawyer who focuses on disability law.
As a law firm built to focus on disability insurance, our lawyers specialize in disability insurance. We spend every day working to get our clients long term disability benefits approved.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
If your claim for long term disability benefits was denied or being delayed by an insurance company, call us to speak with a disability insurance attorney.
We represent clients everywhere with:
submitting a disability insurance claim;
appealing a long-term disability denial;
negotiating a lump-sum settlement; or
filing a lawsuit against your disability insurance company.
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