Tell Us Your Story

This is the second time that this ERISA long-term disability claimant appealed and won a denial of benefits.

In most disability policies, an insured is paid during the first 24 months of benefits if they cannot perform their “own occupation.” After 24 months they are entitled to benefits only if they cannot work at “any occupation.”

The claimant was a senior systems analyst who became disabled after struggling with Rheumatoid Arthritis, Osteoarthritis, Dequervain’s Syndrome (similar to carpal tunnel syndrome) and myriad other related conditions.

In this case the claimant was first denied benefits during her “own occupation.” That denial was appealed and the denial was reversed and benefits reinstated. After several months of payments, however, the plaintiff entered the “any occupation” period and CIGNA again terminated benefits. CIGNA argued that even though it agreed that the claimant could not work as a “systems engineer” that she could work as a “project director.” It based its decision to deny benefits on an independent medical examination and a vocational rehabilitation expert who did a “transferable skills analysis.”

Thus a second appeal was undertaken. The principal arguments made in support of the claim included:

  1. CIGNA had cherry-picked information from the IME while ignoring the conclusion;
  2. There was no material difference between a “systems engineer” and a “project director” for purposes of CIGNA’s disability policy;
  3. The vocational rehabilitation review and “transferable skills analysis” were unscientific and would not be accepted by a federal court;
  4. CIGNA has arbitrarily ignored the claimant’s undisputed high pain levels.
  5. A comparison of various physical capacity forms fills out over several years by the treating physicians showed that her condition had worsened over the years;
  6. When the claim file was closely examined it was apparent that CIGNA’s own medical reviewers agreed that the claimant was disabled.

CIGNA reinstated benefits.  The expected lifetime value of the monthly benefits is $204,100.  

$204,100 of future disability benefits

Why BenGlassLaw? 

  • We file more disability appeals and lawsuits claims that any other firm in our region. (Source: Pacer, the official government site for Federal Court lawsuits)
  • When we get you back on claim, we stay with you for the life of your claim and proactively manage your ongoing benefits - it's never you v. the insurance company again. At the end of 2021, we had $33 million in future disability benefits under management for our clients.
  • In 2021 and 2022, we recovered over $3 million in wrongfully denied disability benefits (we get money for the client in over 90% of the cases that we accept for representation).
  • When we represent you in a claim that has been denied, we only get paid if we win. 
  • We help people all over the country, using local counsel when required, at no additional charge to the client. We believe that disability claimants should have access to the right attorney for them, no matter where they live.
  • Our reviews speak for themselves.
  • Ben Glass has taught attorneys all over the country about ERISA processes and education. He is a subject matter expert in the industry.
  • We give free resources because our passion is empowering the sick and injured to make great decisions about their insurance claims. Download Ben's book - a comprehensive disability claim guide here. 
  • Has your disability claim been denied? We offer free denial letter reviews - send us your letter and our highly experienced team will give you a complimentary and confidential strategy to move forward.
Ben Glass
by Ben Glass
Connect with me
Ben Glass is a nationally recognized ERISA disability & life insurance attorney in Fairfax, VA.