Cigna is a major long term disability insurance company that often tries to avoid paying out disability benefits to its policyholders. Many of our clients with these types of conditions have had their claims for disability benefits denied by Cigna. They choose Marc Whitehead & Associates to handle their appeal because of our thorough knowledge of the disability benefits claims process and our impressive track record when it comes to successfully appealing a denial of disability benefits.
Marc Whitehead & Associates recently represented a 48 year old man living in Houston, TX, who was denied his claim for disability after his physician diagnosed him as suffering from Huntington’s disease. Huntington’s Disease is a fatal genetic disorder which causes the nerve cells in the brain to “break down”, resulting in progressively disabling motor, cognitive and psychiatric symptoms that include:
- Personality changes
- Mood swings
- Impaired judgement
- Unsteady gait
- Involuntary movements (chorea)
- Problems with articulation/slurred speech
- Difficulty swallowing
- Substantial weight loss
According to the Huntington’s Disease Society of America, these symptoms progress over the years until the death of the individual; the average length of survival after diagnosis is normally only 10-20 years. There is currently no cure or treatment which can halt, slow or reverse the progression of Huntington’s Disease, but drugs, physical therapy and behavioral therapy can help manage some of the symptoms.
There Was No Reason to Deny Our Client’s Disability Claim
Our client submitted his claim to Cigna — properly filled out and well within the required deadline — only to have it denied. We carefully reviewed and examined his case and discovered no justifiable basis for the denial. The only explanation we could determine for his denial was that the Cigna simply failed to take into account the significant functional limitations resulting from our client’s cognitive impairments.
It was our opinion that Cigna’s LTD denial and decision to close our client’s claim constituted an incorrect determination and that our client’s medical impairments resulted in a functional capacity that falls well below the standard of a potentially dangerous occupation which requires significant safety standards. Thus, we had to prove that Cigna’s denial and decision to close our client’s claim constituted an incorrect determination. With only a 180 day window in which to take action, we immediately got to work preparing a solid and detailed appeal on our client’s behalf.
Appealing Cigna’s Denial of Disability Benefits
When creating a Cigna appeal, we always include comprehensive medical documentation supporting our client’s disability.
In this case, we were able to include a very thorough neuropsychological evaluation along with his extensive medical records. This neuropsychological evaluation, which details our client’s impairments, was presented as objective diagnostic evidence of our client’s inability to fulfill the essential functions of his or any occupation.
We began by providing an explanation of Huntington’s Disease, its debilitating symptoms and how it affects our client, an electrician by trade, and his ability to perform his job.
Due to his disability, our client has difficulty with articulation (intermittent stuttering, slurring of his words), sleeping, his memory (how he is often forgetful as to where things have been placed), concentration, and mood (often plagued by depression and anger). We provided medical evidence pertaining to our client’s severe problems with anhedonia (the inability to feel pleasure — a common symptom of depression), loss of appetite, decrease in weight, insomnia, and psychomotor retardation due to fatigue.
Being an electrician is a risky occupation, even for persons in excellent health. Our client’s employers were aware of his cognitive problems and shared their concerns about our client’s inability to perform his job due to his condition. We shared an incident in which our client struck a parked police car while trying to maneuver his work vehicle into a parking spot.
What it Means to be “Disabled from Any Occupation”
In addition to medical documentation, we had the advantage of the Social Security Administration’s (SSA) determination that our client is disabled from working at any occupation.
Rather than require only that a claimant be unable to perform the material duties of his own occupation, the Social Security Act requires that a claimant for disability benefits be unable to perform the material duties of any occupation for which he is reasonably suited. This means literally any occupation existing in significant numbers in the national economy and within the claimant’s functional capacity.
The fact that our client was awarded SSA Disability Benefits was a clear example of documented disability.
All this effort was worth it; Cigna reversed their previous decision and granted our client the long term disability benefits that he deserved.
Nationally Recognized Cigna Disability Insurance Claim Attorneys
Marc Whitehead & Associates represent claimants at all stages of the disability claim process. If your claim for disability benefits has been denied by Cigna, please reach out to us without delay. You can schedule a free consultation with one of our experienced Cigna Disability Claim Attorneys to discuss how we can obtain the disability benefits you are entitled to.