Our client, a senior systems analyst, became disabled with Rheumatoid Arthritis, Osteoarthritis, Quervain Syndrome (which is very similar to carpal tunnel syndrome) and a myriad of other disabling conditions. Her employer’s ERISA long-term disability plan originally approved the claim and began to pay monthly benefits. Then, on the basis of physical therapy notes regarding treatment for the lower back, benefits were terminated.
The notes specifically referenced decreased pain, stiffness, and swelling and a mild increase in lumbar ROM (range of motion). An ERISA administrative appeal followed which argued, in large part, that CIGNA had ignored large portions of the medical records that demonstrated that the claimant’s hand and cervical spine pain and limitations had not improved. The appeal included an extensive analysis of ERISA case law, updated witness statements, and additional medical literature.
CIGNA reinstated benefits.
The expected lifetime value of the monthly benefits is $262,158.