Recent News About Cigna and Long Term Disability Claims:
- In Wagenstein v Cigna, the 9th Circuit Court of Appeals remanded a claim to the District Court where Cigna had failed to provide a copy of a report it relied on until the day it denied the claim. The claimant argued that this deprived her of a full and fair review and the Court of Appeals agreed.
Long-term disability insurance is unlike Social Security disability or workers’ compensation. Cigna, and other insurance companies like them, are allowed to “write their own rules,” and even federal judges believe the case law is too confusing for average people to understand.
BenGlassLaw is one of the few law firms in Virginia that handles these types of claims. We work on claims that are denied by Cigna daily, and we know the many “strategies” that these insurance companies use to deny claims.
You’ve Received a Denial Letter from Cigna. What Should You do Next?
Occasionally insurance companies will send you a letter telling you they are reviewing your claim. We call this the “we’re about to deny you” letter, and it’s the first signal that your claim is under review by the insurance company. They may send you an evaluation of your medical condition made by an independent physician advisor, or they may tell you that your claim is under review and they have concluded that an “adverse benefit decision on your claim is warranted.” They might also fail to tell you of favorable reports that they have in the file, but that's another story for another day.
When you receive a denial letter, you should take immediate action. However, don’t just send a letter to the insurance company that says, “I appeal.”
Private disability companies like Cigna require that all the evidence supporting your appeal be submitted by the deadline. If you send an “I appeal” letter, the insurance company will only review your appeal based on the information they already have. We have never seen an insurance company reverse a denial when the claimant sent a simple letter saying, "I appeal."
You can review our article on how to properly appeal an ERISA disability appeal. However, this is not something we recommend that you do without an attorney. Even federal judges say… “[ERISA Claimants] who are not able or aware enough to hire legal counsel before the administrative process is complete likely enter into judicial review facing a loaded deck.”
Here’s How BenGlassLaw Can Help You Right Now with Your Cigna Claim
- Fax/email/mail us your denial letter. We will review it and give you a detailed strategy for moving forward. This service is FREE, but you must act promptly before your timeline to appeal runs out. You only have 180 days within which to file all of your arguments, witnesses, medical articles, legal citations, updated medical records, and narratives.
- Download our free book, Don’t Try This at Home. Don’t Try This at Home is our premier guide on ERISA disability claims where you will learn about why insurance companies deny claims and how you can appeal.
- Contact us about a consultation. We can review your claim and the evidence you have supporting your appeal. Additionally, we will talk to you about how this may affect your current employment and answer any other questions you may have. (There is a nominal fee for this consult, but we have saved claimants thousands of dollars just in one meeting.)
- If your benefits have been denied and you did your own appeal, we can only help you if you have a second appeal available to you. Really, you should contact an attorney before your claim gets this far - second appeals are tough, and there is often extra work to be done by untangling errors made in the first appeal if it was not prepared by an ERISA experienced attorney.
You Can Speak with Our Team of Experts About Your Disability Claim by Calling Our Office at (703)584-7277.
What Information Should You Gather to Appeal Your Cigna Disability Claim?
Before you and your attorney appeal an ERISA disability claim, you need to gather documents from:
- Your Employer
Often claims are denied because there is a dispute over whether you can perform your job duties with your disability. It is helpful to have a description of your job provided by your employer that you can review and compare to the description of your duties in your disability claim. “Sedentary” jobs are notorious for generating disability denials, but “sedentary” may not cover the full scope of your duties.
- Your Doctor
How your doctor interprets your disability and your ability to work is critical for your appeal. You probably already have your doctor’s support, but the insurance company may disregard or overlook your doctor’s input on your disabling condition.
- Your Disability Insurance Provider (Cigna)
Most people don’t know this, but you can and SHOULD request your claim file from Cigna. You should know and understand why the insurance company denied you, and you will want to review their “evidence” about your claim. Bring this with you when you meet an attorney, it will help the attorney understand why you were really denied when reviewing your claim.
Why Most ERISA Long-Term Disability Claims are Denied and How Victims Lose Out on a Fair Recovery - Find Out More in Our Disability Claim Guide, Don't Try This At Home
If your claim for long-term disability benefits has been denied, you need to download this free guide right now. In most cases you have only 180 days within which to file a properly framed appeal. A respected federal judge has said that when you have one of these policies you are purchasing an invitation to a "legal ritual" that you will lose.
Ben Glass's Long-term Disability Book Will Show You:
- How the way you fill out your claim form can wreck your case;
- How doing the appeal yourself can give the insurance company an excuse to deny your claim;
- Why a Federal Judge said that claimants without an experienced ERISA disability attorney are at a 'distinct disadvantage' when appealing their claim denial;
- What you must have in your hand before you file your claim if you want to have any hope of getting paid;
- How to find a board-certified lawyer;
- How one former insurance company employee describes the claim denial process inside one of the world's largest disability insurance companies (you will be shocked);
- How the insurance companies use video and other secret surveillance to try to deny you benefits;
- How one company used an errant checkmark on a physician's form to deny benefits and what we did about it to get benefits restored.
We want to get our guide in your hands right now. You will also have an opportunity to request our disability claim information package after you request this guide.
Ben Glass walks you through the process in his free book, Don't Try This at Home - Your Disability Claim Guide. It's free for Virginia residents!
This free book should be read by:
- Anyone who is filing a disability claim or has already been denied.
- Any doctor who treats patients who are making long-term disability claims.
- Anyone who is going through the disability appeals processes and wants to know more.
What Are The Most Common Reasons Cigna Denies Claims?
Insurance companies are highly motivated by their ability to profit. This should be a given, considering that insurance companies are notorious for denials or low-ball offers. If they weren’t, you would never need an attorney!
Denial Reason #1 – The Insurance Company Doesn’t Think You’ll Appeal
Many people who are denied don’t do anything at all, primarily because the process to appeal and ERISA denial is too complicated for the average person (even the average attorney) to fully understand. Insurance companies save themselves millions of dollars by denying claims and hoping the claimant won’t appeal.
Denial Reason #2 – Your Actual Job Duties Are Different from Your Job Description
Too often, the insurance company denies claims because they have generalized or minimized your job duties to suit their narrative. This often happens with jobs that are partly sedentary. If the insurance company determines that 100% of your job is sitting at a desk (when in reality you have to travel or do heavy lifting), they deny and say that you can perform a sedentary job with your disabling condition.
Denial Reason #3 – Your Diagnosis is Disputed
The insurance companies hire their own doctors to review medical records, and these doctors have an incentive to refute a diagnosis (after all, if they keep denying claims for the insurance company, they get to keep their jobs). These “independent medical reviews” are not as independent as they seem, and we frequently have to refute these reviews for our clients.
This is particularly true for mental illnesses and “controversial” diagnoses like Lyme disease.