Was your disability claim denied by Cigna? The attorneys at Marc Whitehead & Associates help Cigna policyholders in their fight to obtain their rightful benefits. As disability lawyers advocating for victims of denied claims, we understand the importance of filing an appeal that is meticulous and complete.
A Global insurance corporation, Cigna – also known as Life Insurance Company of North America (LINA) – offers long term group disability insurance through the workplace. These policies are governed by the Employee Retirement Income Security Act (ERISA). Under ERISA regulations, the first step to fight the denial is to file an administrative appeal with Cigna. You must exhaust all administrative appeals procedures before you can file a lawsuit.
When dealing with Cigna disability claims denial, you must have a strategy to deal with the company, as well as the rules and timetables governing ERISA claims. We provide you with essential tips to follow in order to be successful in getting the disability benefits you deserve.
Five Tips for Winning a Cigna Disability Appeal
#1: Understand Your Appeal Deadline and Prepare Early
The administrative appeal is much more than just a letter to Cigna explaining why they should approve your claim. It is the only opportunity you have to submit key evidence of your disability into the records. For this reason, the administrative appeal becomes the framework for the successful outcome of your entire case. The point to remember is that usually you only have 180 days to file your complete appeal and it can take months to prepare the appeal properly. Waiting to the last minute can be fatal!
There is no substitute for the representation of an experienced Cigna disability claims attorney in these matters. A properly handled administrative appeal presents Cigna with the full facts of your case, lets them know that you have the power and resources to fight the denial, and fully prepares you to file a lawsuit if that becomes necessary.
The administrative appeal is reviewed by Cigna. If the administrative appeal is denied, you are free to file an ERISA lawsuit in which a federal judge reviews your case. Once a lawsuit is filed, no further evidence can be added to the record.
The importance of properly preparing the administrative appeal cannot be emphasized enough. As explained below, a Cigna disability claims lawyer fulfills many tasks to provide the necessary medical, occupational and legal support to convince Cigna to reverse its denial, and to reinforce the administrative record in the event a lawsuit against Cigna is filed.
#2 Get the Claim File from Cigna prior to Submission of Appeal, and Look at the Total Picture.
To overturn denied Cigna disability claims on appeal, we need to effectively argue against Cigna’s in-house medical reviews, claim handling procedures, and any distortions or misrepresentation of the evidence made by Cigna. This means examining what Cigna’s internal review consisted of and their strategies in handling your case. For instance,
- Did Cigna use video surveillance to record your activities?
- Are they asserting you are “non-compliant” in taking medication or treatments as directed by their doctor?
- Is Cigna basing their findings on an in-house medical review?
- Is their in-house physician misinterpreting the facts of your own doctor’s medical records?
- Did Cigna base any part of the denial on social media research as a means of demonstrating your ability to work?
- Is Cigna misrepresenting a physical disability for one that is based on a mental condition?
#3 Understand the Coverage Limitations & Exclusions in Your Insurance Policy
Most disability policies limit benefits for certain types of conditions. For example, disabilities based on mental or nervous conditions such as anxiety disorders, depression or PTSD, as well as self-reported symptoms such as fibromyalgia, chronic fatigue syndrome or chronic pain are usually limited to only 24 months of benefits.
Your disability policy may have a clause that describes “mental/nervous condition” yet these conditions are difficult to medically and objectively measure. Effective demonstration of evidence to prove your claim for a mental/nervous condition is critical.
Likewise, self-reported disabilities generally cannot be determined by standard objective medical testing such as MRI, blood tests and x-rays, and require the claimant to substantiate evidence of their condition by other means.
Certain types of claims are excluded all together. Most policies have a pre-existing condition exclusion as grounds for claim denial.
Also, the definition of disability usually shifts from an “own occupation” standard to an “any occupation” standard after 24 months, making it harder to continue to receive disability benefits over time.
It is therefore important how you frame your Cigna disability appeal to reinforce the record during the administrative appeal process to avoid having your disability incorrectly classified or otherwise running into trouble with the language of the policy.
#4: Load the Administrative Record with All Your Evidence of Disability
Most medical records and reports from doctors and hospitals, while professionally accurate, are insufficient for proving Cigna disability claims. You must therefore “perfect” the administrative appeal and load the record with fully developed medical and vocational evidence in support of your impairments. This means reinforcing and strengthening the record with
- medical expert opinions
- objective medical testing
- vocational expert reports
- employer’s statements
- affidavits from co-workers, key witnesses, family and friends
- residual functional capacity reports
- accurate job descriptions and information about work experience
- medical literature and photographs
- all other evidence that document your disability.
Loading the record at this point ensures that the information needed to prove you are disabled is part of the record, and is in good order for fighting a lawsuit later.
A major mistake that we see often is thinking additional evidence can be developed and added later. Remember, once the administrative record is closed, No New Evidence Can Be Submitted.
#5 Assume You Are Under Video Surveillance
Cigna and other insurance companies routinely do video surveillance of disability claimants. Generally this is a legal activity as long as they do not invade your privacy by videoing you inside of your home. Cigna does not need your permission to video you. Should the case go to trial, disability video surveillance can be examined by the judge.
The purpose of surveillance is the catch you in some activity, such as doing errands or chores, that would support the insurance company’s allegations that you are able to work. Be prepared to be videoed at any time, even at the start of a disability claim. You might also expect a good chance of being videoed before and after an Independent Medical Examination is scheduled, or during the period of time when your disability policy shifts from “own occupation” to “any occupation.” For denied claims, insurance companies are after the right footage that can assist them in making sure a claim stays denied.
An experienced disability lawyer will be able to effectively refute surveillance as not correlating with the requirements of working 8 hours a day and your physician’s assessment.
More Help with Cigna / LINA Disability Claims
By preparing a quality administrative appeal, you are essentially building your entire trial. To truly understand what you may be dealing with in a battle against Cigna (and other disability insurance providers), we urge you to download a free copy of our eBook, Disability Insurance Policies.
If your Cigna disability claim has been denied and you need an experienced disability attorney, do not hesitate to contact Marc Whitehead & Associates for a free consultation. Wherever you live, we can assist you.