The claimant started with Taco Bell in the ’90s and had worked her way up to Assistant Manager by 2005. When taking out the garbage at home on Christmas Eve in 2011, she became short of breath and nearly fainted. The diagnosis: Multiple Myeloma, a cancer of the blood which affects white blood cells and has severe symptoms such as bone pain and cardiac amyloidosis, or “stiff heart syndrome,” which combined will eventually lead to organ failure and death.
Cigna approved the initial claim for long-term disability benefits and paid without incident until, seemingly out of the blue, they sent a denial letter on February 13th, 2018.
In the denial letter, Cigna stated that, according to their findings, the claimant could now work as an “Assignment Clerk” or a “Table Worker.” We researched in the industry-standard Dictionary of Occupational Titles, used by insurance companies to “find” jobs for people claiming disability. “Table Worker” is a job that includes watching tiles for imperfections as they pass on a conveyor belt - a career last updated in 1977, which is unlikely even to exist today.
In “finding” this job, Cigna failed to acknowledge all the doctor reports and documented test results that prove the claimant is unable to focus for long periods of time, suffers from pain when sitting, and is severely limited in repetitive or short cycle work by fatigue due to the effects of Multiple Myeloma and Stiff Heart Syndrome. Other test results Cigna ignored include a Neuropsychological exam which measured 11 temperaments needed to perform work adequately. Due to her illness, the claimant was impaired on 8 of 11 tests. Cigna didn’t challenge this – they simply ignored it.
We won this appeal by submitting evidence that showed the treating physicians and even the “independent” medical reviewers hired by Cigna all agreed that the claimant was permanently disabled from working due to symptoms such as bone pain, muscle weakness, severe fatigue, blurry vision, cognitive deficits, and poor balance. We showed that in their denial, Cigna had cherry-picked favorable bits and pieces from the medical reports (because even terminal cancer patients have some good days noted by their doctors) and had “found” two jobs for the claimant without considering the pain, fatigue and cognitive impairments which were clearly documented in the medical records.
