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Dabdoub Law Firm Appeals CIGNA’s Termination of Hilo Client’s STD Benefits

Our client from Hilo, Hawaii, was thriving working as a Senior Underwriter since 2017 until she had to stop working in March 2021 due to Trigeminal and Occipital Neuralgia. Her condition had worsened and left her unable to work in any capacity.

She submitted a claim for short-term disability (STD) benefits with the Life Insurance Company of North America (CIGNA). The insurance company approved her request and began making monthly payments in April 2021 until it suddenly reversed course and terminated her benefits at the end of July 2021.

Our client’s condition had not changed, and her medical records had shown no improvement in her disability. Shocked by CIGNA’s irresponsible termination, she reached out to Dabdoub Law Firm to help her appeal to obtain the reinstatement of her STD benefits.

Medical Records Demonstrate Our Client’s Disability

Our Hilo client was diagnosed with Trigeminal Neuralgia, a chronic pain condition that causes extreme, sporadic, and shock-like facial pain. These symptoms can negatively impact both physical and mental health and capacity for both simple daily tasks and professional duties. Episodes can last from a few days to several months. Even with adequate medications, treatment usually loses some of its effectiveness as the condition progresses.

Our client’s doctors also diagnosed her with Occipital Neuralgia which is a severe type of headache that involves piercing and throbbing pain in any part of the head and the upper neck. It also causes extreme sensitivity to light.

Neuralgia Is a Progressive Condition That Does Not Go Away

Both Trigeminal Neuralgia and Occipital Neuralgia are rare neurological disorders that generally do not go away regardless of treatment and whose symptoms usually worsen over time. Although doctors may manage Trigeminal Neuralgia with a personalized treatment plan that can involve medications, injections, and possibly surgery, the condition is likely to “cause longer, more frequent bouts of searing pain” according to the Mayo Clinic.

Trigeminal Neuralgia also has a long list of triggers that are as simple as touching one’s face, eating, drinking, talking, smiling, washing one’s face, or brushing one’s teeth. The unpredictability of both conditions’ symptoms makes it extremely challenging to manage and have an established routine of any kind, let alone a professional occupation.

CIGNA Did Not Fulfill Its Fiduciary Obligations Toward Our Hilo Client

Under the Employee Retirement Income Security Act of 1974 (ERISA), all insurance providers have the obligation to objectively review medical and non-medical evidence provided with a claimant’s petition. CIGNA had to keep our client’s best interests at the center of its work, and it failed to do so, thus breaching its fiduciary duty.

Courts have held in disability cases that “a total disability determination cannot reasonably hinge on whether an employee is minimally capable, on a good day, at the right hour, of fulfilling her job duties in a barely tolerable fashion,” like in Peterson v. Federal Express Long Term Disability Plan.

This applies to our client’s case because she may experience minimal and temporary relief at times, but her unpredictable and debilitating symptoms can happen at any time. Her medical records clearly establish how her two neuralgia disorders prevent her from having full-time employment.

CIGNA stated in its termination letter that our client had no further need for STD benefits because she “had a healthy appearance, normal body habitus, normal alignment, motor strength 5/5 for upper and lower extremities, normal straight leg raise, sensation is intact, and functional loss was unclear.” This opinion showed a complete lack of understanding of our client’s disabling disorder.

Following Dabdoub Law Firm’s appeal and the submission of additional reports, CIGNA reversed course and reinstated our Hilo client’s STD Benefits in the summer of 2022.

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