Receiving a denial for your long-term disability claim from Cigna can be extremely frustrating and stressful. If you’ve been denied, you might be wondering what steps to take next to challenge their decision regarding Cigna insurance long-term disability denial. This article will guide you through understanding why Cigna denies claims and how to effectively appeal their decision, ensuring you have the best chance to secure your long-term disability benefits.
Key Takeaways
- Seeking legal assistance can help navigate the complex appeals process and increase your likelihood of success in securing long-term disability benefits.
- Cigna often denies long-term disability claims due to insufficient medical evidence and specific policy exclusions, so it’s crucial to understand these reasons when preparing an appeal.
- Gather and submit comprehensive medical documentation and meet the 180-day appeal deadline to significantly improve your chances of overturning a denial.
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Navigating Cigna Insurance Long-Term Disability Denial: Steps to Take
Facing a disability claim denial from Cigna can be overwhelming, but understanding the process and preparing strategically can make a big difference. Cigna’s policies, combined with general long-term disability laws, require careful attention to detail to build a strong case. These benefits are essential for providing financial support when serious health issues prevent you from working.
Like other insurance companies, Cigna has a financial incentive to minimize payouts. This often leads to denied claims due to minor errors or missing documentation. Knowing this can help you prepare a more thorough appeal and avoid common pitfalls.
Getting professional legal assistance can significantly improve your chances of success. Experienced disability lawyers understand the appeal process and know how to meet strict requirements and deadlines. Their guidance can help you challenge Cigna’s denial effectively and secure the long-term disability benefits you’re entitled to.
Common Reasons for Cigna Long-Term Disability Denials
Understanding why Cigna denies long-term disability claims is vital for preparing a strong appeal. Common reasons include insufficient medical evidence, policy exclusions, pre-existing conditions, and not meeting the specific definition of disability.
These denials cause significant emotional and financial distress, making it crucial to address these issues directly.
Insufficient Medical Evidence
A lack of adequate medical evidence frequently leads to the rejection of claims. Cigna mandates that a claim be supported by extensive documentation, encompassing all records pertaining to treatments and consultations related to your medical condition. Insufficient or scanty evidence can heighten the risk of your claim being denied. It is crucial to collaborate with healthcare professionals involved in your care to gather complete and relevant information for submission.
In instances where denial arises from inadequate medical evidence, fortifying your case entails collecting supplementary documents as well as possibly submitting yourself for additional examinations. This rigorous gathering process aims at establishing a more solid foundation on which you can counteract the grounds on which Cigna has dismissed your claim.
Policy Exclusions and Pre-Existing Conditions
Exclusions in Cigna’s insurance policies for pre-existing conditions often present significant obstacles. Should your condition have been present prior to the activation of your policy, it may serve as grounds for Cigna to reject your claim.
These policy exclusions tend to be wide-ranging and encompass a multitude of conditions and situations. It is Essential to fully comprehend the scope of these exclusions before you proceed with submitting a claim.
Failure to Meet Definition of Disability
To qualify for benefits, you must align with Cigna’s particular disability criteria. These stipulations demand that your ailment obstructs the execution of your occupational responsibilities and reduces your earnings to below a specified threshold of your income. Should Cigna conclude that you retain the capability to work, albeit under specific limitations or in an alternate role, it could result in the rejection of your claim.
Adherence to this precise definition is critical for ensuring the approval of your claim.
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What Should You Do if Your Disability Claim Was Denied by Cigna?
Have you received a letter from Cigna denying your disability claim? You are far from alone. We see denial letters from Cigna every day, and in most cases we can help. If Cigna has denied either your short-term or long-term disability claim, send us your denial letter for a free strategy review.
This is extra important if your claim is under the Employee Retirement Income Security Act (ERISA). If your employer purchased the disability insurance policy from Cigna for you, then most likely your claim is an ERISA claim. And ERISA claims are tricky!
Under ERISA, by law, Cigna must follow certain rules. However, ERISA is very difficult to navigate and that makes it hard for YOU, the claimant, to know what the rules are. Of course, it’s hard to hold Cigna accountable if you don’t know the rules they are supposed to be playing by. And Cigna wants to keep it that way. Cigna will want you to believe that it’s easy to appeal your claim denial decision without an attorney. It may be easy (your Cigna claim manager will tell you that all you need to do is write “I appeal,” and your claim will be reviewed) but it is NOT smart. After you write “I appeal,” Cigna will simply write, “We reviewed our decision and we were right all along. Your claim is still denied.”
To protect yourself, you should talk to a lawyer who has experience with ERISA before appealing any short-term or long-term disability denial by Cigna. At BenGlassLaw, we will review your denial letter and send you custom feedback for free. There is no reason not to get an attorney’s opinion about your denial.
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The Appeal Process for Cigna Long-Term Disability Claims
The appeal process for Cigna long-term disability claims is structured and involves multiple steps, governed by ERISA, which grants Cigna significant authority over claim evaluations. Understanding the steps involved and preparing thoroughly can greatly improve your chances of a successful appeal.
Usually, an appeal of Cigna’s denial of your ERISA disability claim starts like this:
- You have 180 days to appeal from the date you received Cigna’s denial letter to file your appeal. This is called an administrative appeal. This means that someone at Cigna will review your appeal and make a decision;
- Cigna will have 45 days to answer your appeal;
- Cigna is allowed one 45-day extension.
Preparing Your Appeal
Assembling your appeal requires the compilation of all essential documents to create a complete appeal package. This package is final once it enters litigation, meaning that you must incorporate every pertinent piece of medical documentation including evaluations and physician testimonies from the outset. To enhance your case, consider obtaining supplemental assessments such as MRIs, laboratory tests, or x-rays.
Should there be an anticipation of medical improvement, Cigna might seek fresh statements from the physicians overseeing your treatment. Securing comprehensive and up-to-date documentation along with current medical records is vital in forging a robust appeal that may improve your likelihood of prevailing.
Submitting Your Appeal
To enhance the strength of your appeal, it is essential to gather supplemental medical records, statements from your physician, and any pertinent documentation that substantiates your claim. Ensure you abide by the critical timeframe of 180 days to file an appeal following the receipt of Cigna’s denial letter.
Crafting a succinct and well-articulated letter for your appeal that presents a comprehensive overview of your case with all required evidence included can notably bolster its effectiveness.
IMPORTANT NOTE: DO NOT, under any circumstances, miss this 180-day window. If you do not file an appeal, your claim is dead. You cannot sue Cigna for denying your claim unless you first filed a timely appeal.
What to Expect During the Review
Once you have lodged an appeal with Cigna, they will conduct a comprehensive examination of your medical condition and associated claim. The length of this review may differ from case to case, and those appealing should be prepared for possible postponements. In the course of their evaluation, Cigna might seek Details or elucidation concerning your health condition and its treatment.
Maintaining open lines of communication and swiftly addressing any inquiries from Cigna can aid in advancing the process without unnecessary delays.
Long-Term Disability Lawyers for Cigna Disability Claim Denials
Securing legal help is often a vital step in effectively managing the appeals process following denials of disability claims with Cigna. Lawyers specializing in disability, like our team here at BenGlassLaw, provide essential representation and knowledge to challenge the decisions made by Cigna regarding claim refusals.
The probability of overturning a denial through an appeal increases with professional legal support, given the intricate nature of Cigna’s procedures for handling claims related to disability.
When to Seek Legal Help
Should you believe that your claim with Cigna was unjustly rejected, it is advisable to engage the services of an attorney who specializes in handling Cigna cases. This step becomes crucial when faced with repeated rejections despite the legitimacy of your claim or if the rationale behind the denial has not been clearly explained.
Promptly seeking counsel from such a lawyer can be instrumental in steering through the complexities of legal proceedings and bolstering your prospects for overturning the denial on appeal.
How an ERISA Lawyer Can Help
Attorneys specializing in ERISA law are instrumental when individuals must contend with the appeals process of long-term disability claims. These legal experts offer vital support to construct and present compelling arguments against claim denials, ensuring that appeals are meticulously prepared.
Due to the intricate nature of ERISA regulations and the significant authority wielded by insurance companies over long-term disability claims, securing legal counsel is critical for achieving a favorable outcome.
Contact us now for a free, zero-obligation consultation to learn if we can help you.
Choosing the Right Attorney
Choosing an experienced attorney is essential to successfully maneuver through the complicated appeals process for disability claims. It’s important to find a lawyer with specific knowledge of ERISA cases since this expertise is crucial in grasping the nuances of Cigna’s policies and the legal statutes that oversee disability claims.
There’s a reason our team has over 300 five-star reviews and great case results on behalf of our clients.
Avoiding Common Mistakes in the Appeals Process
Steering clear of typical blunders throughout the appeals process is vital for obtaining a favorable result. Minor slip-ups could cause your appeal to be rejected, thus it’s imperative that you meticulously adhere to all specified rules and deadlines with utmost precision.
Recognizing common traps can significantly enhance your ability to successfully maneuver through the procedure, thereby boosting your odds of acquiring long-term disability benefits.
Failing to Provide Updated Medical Records
It is vital to maintain up-to-date medical records in order to prevent Cigna from denying your disability claim. A lack of recent medical documentation can result in a rejection of your Cigna disability claim.
To fortify your appeal, it’s important that your healthcare providers promptly reply to any requests made by Cigna for updates on medical records.
Missing Submission Deadlines
Frequently, claim denials are attributed to the failure to meet submission deadlines. It is essential for the timely filing of claims and appeals since insurers typically set a restricted period in which you can appeal. To prevent difficulties and maintain the viability of your claim, it’s important that all submissions, including documents and appeals, adhere strictly to these predetermined time limits.
Inadequate Documentation
A successful appeal often hinges on the provision of thorough and detailed documentation. It is crucial to bear in mind that an appeal represents your final chance to introduce new evidence, which underscores the importance of collecting and presenting all essential documents to enhance the likelihood of a favorable outcome.
What Happens if Cigna Denies My Appeal?
If Cigna decides that they were correct in denying your benefits, then you have one last option. You can file a lawsuit in federal court.
You will absolutely want an attorney for this lawsuit as it can be difficult to overturn Cigna’s decision in court. Despite courts’ criticism of Cigna’s claim handling, the sad fact is that the law is written to favor insurance companies like Cigna. In fact, of cases that went to a judge to decide, insurance companies like Cigna won 7 out of every 10. Those are long odds!
The lawyers at BenGlassLaw know how to handle these lawsuits. Cigna will try to show that they were right in denying your benefits, but a federal judge will make the final decision. With our help, you can show the judge where Cigna abused its discretion to manage and decide your claim. That is the path to the closure – and benefits – you deserve.
How BenGlassLaw Can Help With Your Cigna Long-Term Disability Claim Denial
Facing a Cigna disability denial is a daunting experience, but understanding the process and knowing your rights can empower you to fight back. From reviewing the denial letter and gathering strong medical evidence to filing an appeal and seeking legal counsel, each step is crucial in securing the benefits you deserve.
Remember, you don’t have to navigate this journey alone. Our team at BenGlassLaw is available to guide you through the complexities of the appeals process and ensure you have the best chance of success — no matter where you’re located in the United States. Stay proactive, informed, and persistent in your pursuit of justice.
Contact our team today for a free, zero obligation consultation to learn how we can help you.
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