If your disability claim was denied by Cigna, Marc Whitehead & Associates are here to help. Let us put our extensive experience and knowledge to work for you. We understand the Cigna disability appeal process and what steps policyholders must take to ensure they receive their rightful benefits.
Cigna — also known as Life Insurance Company of North America (LINA) — offers long term group disability insurance through the workplace. These insurance policies are regulated by the Employee Retirement Income Security Act (ERISA). Under ERISA rules, a policyholder who has been denied benefits must file an administrative appeal with Cigna in order to win their benefits.
Successfully Appealing a Cigna Disability Claims Denial
This administrative appeal will be your only opportunity to submit the key evidence that supports your disability claim into the records and will be critical to the outcome of your entire case.
The importance of properly preparing the administrative appeal cannot be emphasized enough. The disability claim denial attorneys at Marc Whitehead & Associates can provide invaluable assistance when it comes to obtaining and providing the evidence and legal support needed to convince Cigna to reverse its denial.
To successfully appeal a Cigna disability claims denial requires an effective strategy that takes into account both the company and its culture as well as the rules and timetables pertaining to ERISA claims. We’d like to share five essential tips that will help guide you through the appeals process and obtain the disability benefits you deserve.
Five Tips for Winning a Cigna Disability Appeal
#1: Understand Your Appeal Deadline and Prepare Early
It can sometimes take months to properly prepare an appeal. In most cases, you will only have 180 days to file your complete appeal. We recommend that you start working on your appeal ASAP — waiting until the last minute could be a big mistake.
#2 Get the Claim File from Cigna prior to Submission of Appeal, and Look at the Total Picture.
We obtain the total picture by thoroughly examining what Cigna’s internal review consisted of and their strategies in handling your case. We need to find out:
- Did Cigna have you under video surveillance?
- Is Cigna claiming you were “non-compliant” in following their doctor’s instructions?
- Are Cigna’s findings based on an in-house medical review?
- Did Cigna’s in-house physician misinterpret 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?
- Did Cigna inaccurately state your job functions, duties and responsbilities?
To successfully challenge your Cigna disability claim denial, we must effectively argue against Cigna’s in-house medical reviews, their claim handling procedures, and any distortions or misrepresentation of the evidence made by Cigna.
#3 Understand the Coverage Limitations & Exclusions in Your Insurance Policy
We urge our clients to read their policy carefully. There’s a good chance your Cigna disability policy limits benefits for certain types of mental or nervous conditions such as anxiety disorders, as well as self-reported symptoms such as chronic fatigue syndrome. In addition, there’s probably a clause that states any pre-existing conditions you have may be grounds for rejecting your claim, and you’ll discover that your policy excludes certain types of claims all together.
#4: Load Your Administrative Record with All the Evidence of Your Disability
The medical records and reports obtained from doctors and hospitals, while professionally accurate, will often be insufficient for proving Cigna disability claims. To support your claim, we recommend loading the record with fully developed medical and vocational evidence to support your disability claim that can include:
- 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 stage ensures that the information needed to prove you are disabled is part of the record. Please don’t make the error of thinking additional evidence can be developed and added later — once your administrative record is closed, no new evidence to support your claim can be submitted.
#5: Assume You are under Video Surveillance
You should be aware Cigna and other insurance companies routinely conduct video surveillance of disability claimants. They do this in hopes of catching you in some activity that would support their allegations that you are able to work. Cigna doesn’t need your permission to video you as long as they do not invade your privacy by videoing you inside of your home. Examples of video surveillance could be you driving to the grocery store, or out walking your dog.
Social media activity can be equally damaging to your case. Photos and comments posted on Facebook and other platforms could potentially be used against you. We strongly advise that you refrain from discussing your case with anyone but your attorney.
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.
What happens if your appeal is denied?
If your appeal is denied, you may choose to file an ERISA lawsuit to have your case reviewed by a federal judge. Once your ERISA lawsuit has been filed, no further evidence can be added to the record.
To help you understand the disability claims process, we urge you to download a free copy of our Cigna ebook.
Get Answers from a Disability Claims Attorney
Don’t lose out on the disability benefits you deserve. If your disability claim has been denied, contact Marc Whitehead & Associates to schedule a free consultation with one of our disability claims attorneys. We serve clients all across the United States.