Claimant worked for Klockner Metals as a truck loader. He drove a crane and a forklift and moved heavy materials all day, every day. When he could no longer perform the duties required of him at work due to limitations on his ability to move freely and his constant pain, he sought intensive medical help. He was diagnosed with a complex constellation of issues, including degenerative disease of the lumbosacral spine with left sciatica and lumbar spondylolisthesis, and he stopped working April 26, 2016. He was approved by Cigna for Short-Term Disability payments. He saw numerous specialists and began physical therapy. Eventually, he was scheduled for lumbar decompression and fusion surgery. Cigna - while knowing he was awaiting back surgery - terminated the claim for benefits.
Once his disability claim was terminated he lost his health insurance, and without Long-Term Disability benefits, has been unable to afford new health insurance. He now cannot afford to have surgery and remains disabled.
Our ERISA appeal focused on Cigna's numerous procedural and fiduciary errors in processing the claim, including not having an appropriate medical specialist review the claim and not having a vocational analyst who actually understood what the claimant did for a living. Since the medical reviewers that Cigna used had no idea what he actually did for a living they had no rational basis for declaring that he could work.
We argued that Cigna's termination did not meet the "substantial evidence" test under ERISA as set out in Sup v. UNUM Life Ins. Co. of Am., 390 F.3d 301, (4th Cir.2004).
Cigna reinstated benefits and paid all past due benefits shortly after review our extensive appeal.