$93,843 in Back Benefits Recovered for Long-Term Disability

BenGlassLaw long-term disability team recovers $93,843 in wrongly denied benefits under Navy Federal Credit Long-Term Disability Policy

This 66-year-old Senior Internal Auditor for Navy Federal Credit Union developed a major depressive disorder which prevented him from performing his job duties which required a very high level of cognitive function. His claim was supported by his health care providers, but Cigna denied the claim on the basis that (1) there was “no functional impairment provided; (2) “better memory and increased energy” had been documented on a recent office visit and “you were able to complete activities of daily living which is suggestive of a functional capacity.”

Major Depressive Disorder (MDD), commonly known simply as depression, is a serious medical condition that significantly affects a person’s feelings, thoughts, and behavior. It is more than just a bout of the blues; it is a persistent feeling of sadness and loss of interest that can require long-term treatment to manage.

Characteristics of Major Depressive Disorder

Individuals with Major Depressive Disorder may experience a deep, overwhelming sense of despair that impacts all aspects of their daily lives. This can manifest in various ways, including persistent sadness, a lack of interest in previously enjoyed activities, and an overwhelming feeling of fatigue that doesn’t seem to improve with rest. Other common symptoms include changes in appetite or weight, difficulties sleeping or sleeping too much, decreased energy, feelings of worthlessness or excessive guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide.

Impact on Daily Functioning

The effects of Major Depressive Disorder can be profound, impacting a person’s ability to function at work, at home, or in social settings. The persistent nature of the disorder means that symptoms typically last for most of the day, nearly every day, for at least two weeks, and often much longer. For some, episodes of major depression may occur only once in a lifetime, but more commonly, a person may have multiple episodes.

Diagnosis and Treatment

Diagnosing Major Depressive Disorder typically involves a thorough evaluation by a mental health professional who may use specific diagnostic criteria, such as those from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment often includes a combination of medications, such as antidepressants, and psychotherapy. In some severe cases, other treatment options like electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS) may be considered.

Implications for Long Term Disability Claims

When it comes to long-term disability claims, Major Depressive Disorder can be a qualifying condition if it severely impairs the individual’s ability to work. Claimants must provide comprehensive medical evidence demonstrating how their symptoms prevent them from performing their job duties. This can include detailed statements from treating psychiatrists or psychologists, records of consistent treatment, and sometimes, detailed personal accounts of how the symptoms affect daily functioning.

Understanding Major Depressive Disorder is crucial for recognizing its potential impact on an individual’s life and work, and effective management can help mitigate these effects. For those suffering from this disorder, obtaining appropriate medical documentation is key to supporting a claim for long-term disability benefits.

The claimant first appealed on his own. That appeal was denied as almost no claimant ever wins an ERISA appeal submitted without experienced ERISA counsel.

We were retained and an extensive investigation revealed that, over time, the claimant’s job reviews by his supervisors clearly demonstrated that his performance was impacted by his depression. Cigna had never asked for this information nor suggested that the claimant obtain it.

A hallmark of ERISA disability law is that every case must begin with a detailed analysis of what it is the claimant actually does at his/her job. Insurance companies will often try to box every claimant who has an office job into one “job category:” sedentary.

The appeal also attacked the wholesale “cherry-picking” of the medical record by Cigna and the outright dismissal of the opinions of the treating doctors. Generally, an insurance company does not have to give deference to the opinion of the treating physician (and this is different from Social Security law), but it must at least consider and evaluate those opinions. The appeal pointed out that Cigna had not done so.

Cigna has continued to uphold the denial of the short-term disability claim. However, when the same claim file was presented to the long-term disability section of Cigna, that group approved the claim, paid the claim and paid the last two years of benefits.

CIGNA is a global health service company that is well-recognized in the health insurance industry, including its substantial role in the long-term disability insurance market. With its headquarters in Bloomfield, Connecticut, CIGNA offers a wide range of health services and insurance products, among which long-term disability (LTD) insurance is a key component. The company is known for providing these services not only to individuals but also to businesses, offering group LTD policies as part of employee benefits packages.

Market Presence and Services

CIGNA has a significant presence in the U.S. insurance market and operates internationally, which underscores its extensive network and resource capabilities in providing insurance solutions. The company’s long-term disability insurance is designed to protect employees from loss of income in the event of a disability that prevents them from working for extended periods. CIGNA’s LTD policies typically include coverage that provides a portion of the employee’s salary during disability, rehabilitation incentives, and workplace modification benefits to help employees return to work.

Claims and Reputation

In the realm of long-term disability claims, CIGNA is known for a rigorous assessment process. They utilize medical reviews and sometimes require independent medical examinations to verify the extent of a claimant’s disability. While CIGNA is respected for its comprehensive coverage options and global reach, it has also faced criticism and legal scrutiny over its claims handling processes. Some claimants have reported challenges with claim denials and delays, which has led to disputes and litigation.

Importance for Claimants

For claimants navigating long-term disability claims with CIGNA, it is crucial to be thorough in the submission of all medical documentation and to understand their policy’s specific requirements and provisions. Given the complexities and strict criteria of CIGNA’s claim process, claimants often benefit from legal advice to ensure their rights are protected and to assist in managing disputes that may arise.

CIGNA remains a major player in the long-term disability insurance market, offering vital financial protection to those unable to work due to disability, but it is important for insured individuals to be proactive and well-informed when engaging with their policies and the claims process.

Ben Glass leads the long-term disability section of BenGlassLaw, a national leader in representing claimants in long-term disability cases

Back Benefits Recovered for Major Depressive Disorder (Navy Federal Credit)

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