Before filing for long-term disability (LTD) benefits, our client spent 40 years working in coal mines in Birmingham, Alabama. Unsurprisingly, the intense physical labor took a toll on his body, and he was forced to stop working before retirement age. Fortunately, our client thought ahead and held a disability policy for exactly this situation. When his chronic arthritis and other medical conditions became too much to bear, he filed a short-term disability (STD) claim with CIGNA LINA. The insurance company quickly approved his claim, as well as a subsequent claim for LTD benefits.
Unfortunately, when the terms of our client’s policy changed, CIGNA LINA claimed he was remarkably capable of returning to work, despite his deteriorating health. Confused, our client contacted Dabdoub Law Firm for help. We presented a long list of medical evidence to CIGNA LINA, had our client’s LTD benefits reinstated and his retroactive benefits paid in full.
Our Client’s Body Is Deteriorating After 40 Years in Underground Coal Mines
Our client suffers chronic arthritis all over his body, especially on his right side. He suffers from chondrocalcinosis in his right knee, has bone chips and bone spurs in his right elbow, and battles chronic bursitis in his right hip. He also faces swelling in his right calf and experiences chronic back pain because of bulging discs in his spine.
Further, our client has experienced a blood clot in his leg and has been diagnosed with meralgia paresthetica in his left thigh, which leads to daily numbness, stinging, and pain. He also had a heart attack and was diagnosed with coronary artery disease and hyperlipidemia.
To address his multitude of medical conditions, our client has endured multiple surgical interventions. He has undergone right rotator cuff surgery and left Achilles’ tendon surgery. After his heart attack, he also underwent a catheterization and stent procedure. To make matters worse, our client was recently diagnosed with benign prostatic hypertrophy with renal tumors and needs kidney surgery.
CIGNA LINA recognized our client’s struggle when paying STD and later LTD benefits. Even though our client’s condition has only gotten worse, the insurance company mysteriously terminated LTD benefits and claimed our client could return to work, albeit not as a coal miner.
CIGNA LINA Ignores Medical Evidence to Deny Our Client’s Claim Under a Change in Definition
After a beneficiary is disabled from their own occupation and receives LTD benefits for a certain period of time, the definition of disability changes. At this point, the beneficiary can only continue receiving benefits if they cannot work in any occupation.
CIGNA LINA recognized that our client could no longer work as a coal miner but failed to consider the medical evidence and falsely claimed that our client could hold another full-time job. Our client has worked as a coal miner since he was 19 years old and has no other skills or special training. Additionally, he is due for kidney surgery and cannot fulfill the duties of any full-time job due to ongoing chronic pain.
We highlighted this fact by CIGNA LINA by providing the following evidence:
- A functional capacity evaluation (FCE) that stated our client is unable to perform sedentary work because he cannot sit comfortably for more than 5 minutes at a time. According to the FCE, our client would be incapable of fulfilling a 3-hour shift, much less a full-time job.
- A letter from the doctor leading our client’s treatment efforts and medical care. (Our client’s doctor also made a mistake on a piece of paperwork and asked CIGNA LINA to wholly disregard it).
- Our client’s prescription records – which include a cocktail of ambien, amlodipine-olmesartan, atorvastatin, effient, methocarbamol, metoprolol succinate, norco, olmesartan medoxomil, singulair, and tadalafil – and the side effects these prescriptions cause.
- Medical records from our client’s orthopedic team, including objective evidence like MRIs, CR scans, x-rays, and other medical imaging tests.
- Proof of our client’s deeply involved recovery efforts, including repeated and unpleasant injections and heavy-duty medications like Gabapentin.
- Our client’s symptom diary and declarations, which show firsthand how our client’s disability negatively impacts his day-to-day life.
- A statement from our client’s wife, demonstrating how his medical conditions have strained his marriage.
Before his medical conditions interrupted his life, our client was an active, hardworking, and athletic person and confident, dependable husband. He enjoyed hunting, fishing, riding his motorcycle, and providing for his family. Now, our client can no longer work nor do any of the things he once enjoyed. Our client cannot even enjoy the reprieve of sleep at night because his pain keeps him awake.
On top of all of this, CIGNA LINA terminated his LTD benefits, inappropriately taking away the one lifeline our client and his family still have.
CIGNA LINA’s Inadequate Review
Instead of providing a full and fair evaluation and continuing our client’s LTD benefits, CIGNA LINA relied on a change of definition and a flawed review from a nurse case manager to terminate our client’s benefits.
The nurse case manager did not read our client’s doctor’s notes and instead relied on an erroneously completed form. Our client’s doctor realized her mistake immediately and took steps to remedy it, but CIGNA LINA skipped over this information and tried to use one error to avoid liability and – effectively – ruin our client’s life.
This is a clear violation of the Employee Retirement Income Security Act of 1974 (ERISA), which requires disability insurance companies to act in their policyholders’ best interests.
To make matters worse, CIGNA LINA’s vocational review was wholly incorrect, mischaracterizing our client’s physically intense job as a coal miner as a “light occupation” due to his official job title alone.
Dabdoub Law Firm saw CIGNA LINA’s “cherry-picking” for exactly what it was and threatened litigation if our client did not receive his LTD benefits, along with any benefits he missed while CIGNA LINA made its mistakes.
The insurance company remedied its mistakes, reinstated LTD benefits, and paid retroactive benefits in full.
Help From a Lawyer with Expertise in Disability Insurance
That focus means:
- All of our lawyers specialize in disability insurance claims.
- We have experience with every major disability insurance company.
- We have won important long-term disability lawsuits.
Our disability lawyers can help you 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.
If you want to recover the benefits you deserve, you need to hire an experienced disability attorney. Because federal law applies to most disability insurance claims, our lawyers can make the law work for you no matter where you live.
Call us at (800) 969-0488 or contact us online for a free consultation with an experienced disability attorney. We help clients across the country, and we never charge legal fees until our clients win their claims.