Cigna is one of the largest LTD companies offering policies today. If you wish to appeal a denied claim you should seek legal assistance.
Author: Attorney Lonnie Roach
Cigna is a global health company that was established through the merger of Insurance Company of North America (INA) with Connecticut General Life Insurance Company (CG) in 1982.
The subsidiaries of Cigna Corporation offer a variety of health insurance services and products to customers throughout the world including:
- Supplemental Plans
- Behavioral Health
- Vision care
- Health coaching and condition management
- Group life
- Short-term and Long-term disability
In 2016, Cigna earned $39.7 billion in revenues and ranked 79 on the Fortune 500 list.
It served 15.2 million global medical customers and processed 163 million medical claims. Its global network included 108,700 participating healthcare professionals and 13,900 facilities and clinics.
Cigna offers group plans specifically tailored to small, medium and large businesses.
In 2016, 8.5 million customers were covered by group disability plans that provided short-term disability coverage for those temporarily disabled and unable to work and long-term coverage for those out of work for an extended period of time.
If you have been denied disability benefits don’t give up! Contact a Disability lawyer at 512-454-4000 for a Free Consultation and get the benefits you deserve.
If you become disabled and are covered by a disability plan written by Cigna you can initiate a claim via fax, mail, or online at Cigna’s website.
Claimants should go to www.myCigna.com to submit a claim form or download a form to fax or mail. First, choose between the Short-term disability claim form or the Long-term Disability Claim form and then print the Physician’s Statement. Complete each form and fax or mail to Cigna at:
Cigna Disability Management Solutions
Paper Intake Team
P. O. Box 709015
Dallas, TX 75370-9015
You should also complete a Disability Disclosure Authorization Form to grant Cigna access to additional information from your employer and medical providers.
Cigna offers several tips for filing a claim:
- Know your policy terms and what is covered and not covered.
- If you become disabled, file your claim promptly.
- Provide complete information and alert your medical providers that you are filing a claim.
- Communicate. Update your disability company frequently with recent medical information (even if it’s not related to your disability) and keep your employer informed.
- Be proactive. Confirm with your disability company that they have received all necessary information; read notices and letters and ask questions.
- Be mindful of timeframes to submit claims and appeals.
If you receive an adverse decision regarding your claim, Cigna encourages you to call them first before beginning the appeal procedure.
In some cases, an issue can be resolved outside the formal appeal process. If you decide to appeal, a Request to Change an Adverse Decision by Cigna is available on its website. Complete and mail the appeal form within 180 days and a decision will be received in writing. Requests should include:
- The appeal form
- A copy of the original claim and explanation of payment or initial adverse decision letter, if applicable
- Any documents supporting the appeal such as statements from medical providers and facilities and medical records
The appeal may also be submitted in letter form, but the letter must state that it is a “Customer Appeal” and include all of the information listed above.
Requests are reviewed by someone at Cigna who was not involved in the initial decision and who can take corrective action. Decisions are based on the terms of the claimant’s benefit plan and a physician will be involved in any review related to medical necessity. If a situation involves urgent care, the review will be expedited.
Cigna long-term disability policies provided by or purchased through an employer are governed by The Employee Retirement Income Security Act or ERISA.
This law was created to protect employees’ rights to benefits, but unfortunately, most attorneys agree it supports insurers instead. Before filing suit, a claimant must “exhaust administrative remedies.” Claimants have 180 days to appeal and insurers have 90 days to consider the appeal which equals 270 days a disabled person is without income. Claimants are advised to file for Social Security Disability Income when filing a claim, but insurers may deduct any Social Security Income from insurance benefits and, if a claimant does not file for SSDI, the insurer may claim the disabled person has breached an LTD policy requirement. ERISA permits insurers to administer their own plans and a denial can only be reversed by demonstrating that the insurer abused that discretion – which is very difficult to do. If an internal appeal is denied, filing suit in U.S. District Court is a claimant’s last option.
Cigna LTD Claims:
Continuing neck and back problems plagued one Grand Prairie, Texas client, followed by multiple surgeries. After one of the surgeries, one of her treating physicians, a neurosurgeon, stated on Cigna’s attending physician statement that she was unable to work secondary to pain and weakness and that she would never be able to return to work. The client underwent a two-day FCE protocol after which a Board Certified Orthopedic Surgeon wrote that her results were “about the clearest-cut case of someone applying for long-term disability that deserves it that [that physician had] seen in 27 years of clinical practice as a spinal surgeon.” The doctor further indicated that client was not fit for employment and that this would be a lifetime condition. She was awarded SSDI, but Cigna denied her LTD claim anyway. We challenged the denial and Cigna settled.
A Frisco, Texas client suffered from severe, intractable low-back pain. Imaging studies revealed multi-level degenerative disc disease of his lumbar spine.
Because of the extent of the degeneration, his orthopedic surgeon restricted him from bending, lifting anything exceeding ten pounds, and twisting. Even with these restrictions, his doctor stated that the client was unable to return to work due to continuous low back pain, that walking more than 100 feet was virtually impossible for him, and that he was unable to sleep for more than two hours at a time due to pain. Physical therapy only aggravated his condition. The doctor felt that he was unable to return to any type of meaningful occupation for the foreseeable future and that he should be considered persistently disabled until further notice. After CIGNA denied him anyway, he hired Bemis, Roach & Reed. We were able to get him a settlement.
A Dickinson client was denied Short Term Disability by Cigna.
She underwent a neuropsychological evaluation which found cognitive impairments. At the suggestion of the neuropsychologist, she then underwent a Functional Capacity Evaluation which found physical limitations. Both of the tests, which are considered the “gold standard” for making disability determinations, found our client incapable of full-time employment. Her doctor described her limitations so as to include two hours of rest with every one hour of activity. These restrictions were indefinite. Although she could perform some functions, she was limited to part-time work and could not earn 80% of her indexed pre-disability earnings unless she could work at least 80% of a full-time schedule. There was no evidence in the record that she could do so. We fought Cigna when it denied her claim and were granted a settlement.
ERISA disability disputes can be long and drawn out and few disabled people have either the resources or physical stamina to fight with a large insurance company.
That is why it’s important to have a qualified attorney with extensive experience in LTD disputes and ERISA to organize and manage your case. Partner and long-term disability attorney Lonnie Roach of Bemis, Roach & Reed has successfully overturned denials of disability benefits at the administrative level, in United States District Court, and at the United States Court of Appeals. Presently Lonnie represents clients who have been denied or lost insurance, long term/ ERISA or Social Security disability benefits in all four federal districts in Texas. If you have been denied long term disability benefits, Bemis, Roach & Reed offers a free consultation to determine if we can assist you in obtaining or reinstating those benefits. Call 512-454-4000 and get help today.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court – all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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