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CIGNA Long Term Disability Claims and Appeals

CIGNA is a popular issuer of short term and long term disability insurance. Its subsidiaries, Life Insurance Company of North America (or LINA) and New York Life Group Insurance Company of NY, also issue disability insurance.

If you need to file a disability claim with CIGNA, the Maddox Firm can help you file a claim the right way. If you filed a disability claim with CIGNA and it was denied, or if CIGNA terminated your disability benefits, the Maddox Firm can help you appeal that decision the right way. We have handled many CIGNA claims and appeals.

CIGNA Long Term Disability Insurance

CIGNA was formed in 1982 when Connecticut General Life Insurance Company and INA Corporation merged. Subsidiaries of CIGNA include Life Insurance Company of North America or LINA and New York Life Group Insurance Company of NY. The company has 22 million U.S. customers covered by its Group Disability & Life policies. CIGNA has become the fourth largest provider of disability insurance in the U.S. In 2018, the company earned $48 billion in adjusted revenue, and more than $5 billion of that total came from disability insurance and life insurance. Despite record earnings, CIGNA, like many other insurance companies, uses a variety of tactics to deny claims and maximize profits.

CIGNA’s Definition of Disability

To successfully receive short term disability benefits or long term disability benefits, you must meet the definition of disability in the policy. Typically, an employer-provided CIGNA disability policy defines disability as an inability to perform the duties of your own occupation – at least for the first 24 months. After that, the definition of disability likely changes to require that you demonstrate an inability to perform the duties of any occupation.

Some CIGNA policies have different definitions of disability. For example, if you bought your own CIGNA disability policy (as opposed to having it provided by your employer), you may have paid for a different definition of disability. In many policies bought by physicians and other independent contractors, we see additional “riders” that can change certain provisions. Some riders change definition of disability to only require you demonstrate an inability to perform the duties of your own occupation for the entirety of the policy period. Other riders add a residual or partial disability provision. Residual or partial disability riders may allow you continue to work if you can still perform some of the duties of your occupation or if you can still do part-time work. You must also show that you have a loss of income due to the disability. Typically, the loss of income must be at least 20% of prior income. The benefit will be reduced for a partial disability or residual disability claim, but it will not be reduced to zero unless you do not have the required loss of earnings.

Reasons CIGNA May Deny Your Long Term Disability Claim

CIGNA may deny your long term disability claim for several reasons. Among those reasons are:

Lack of Consistent Treatment: You may have failed to maintain consistent treatment with a physician. Most CIGNA policies require that you receive appropriate care from a physician who is appropriate to treat the condition causing the impairment. CIGNA requires that you treat with a physician. Although you may also treat with an alternative medicine or other healing provider. Although it may be a burden to go to the doctor frequently, especially if there is little treatment or change in your condition, it is helpful to your claim that you maintain consistent, frequent treatment.

Pre-Existing Condition: You may suffer from a disability caused by a pre-existing condition. Most CIGNA policies require that the disability be due to a new condition. Pre-existing conditions are usually defined as any condition that you received treatment for or consulted a doctor about, during the three months before the disability insurance began. That said, in many states, pre-existing condition limitations may only act as a temporary waiting period for benefits to begin. Check your state’s law to be sure.

Lack of Medical Records: CIGNA may deny your disability claim if you fail to supply medical records that demonstrate disability. You may have difficulty getting your doctors to cooperate with requests for medical records. Or, you may find that your doctors’ medical records are not sufficiently detailed to provide support for your inability to perform you job. When treating with your doctor, be sure to describe all of your symptoms in detail, including any fatigue, pain, cognitive issues, or side effects of medication. Describe in detail for your doctor what exactly is preventing you from being able to do your job.

Lack of Objective Evidence: Depending on your condition and symptoms, CIGNA may require that you submit objective evidence of disability. What is objective evidence is not easily defined, but in general, objective evidence is evidence that does not depend upon the say-so of the patient and cannot be faked. This may mean, for example, that if you suffer from cognitive issues, that you need to obtain a neuropsychological evaluation. Or, for example, if you suffer from an inability to sit for longer than a certain period of time, you may need to obtain a functional capacity evaluation. There are other tests that are specific to each set of conditions and symptoms. Deciding which test will help provide objective evidence is an important part of the process of filing a disability claim.

Surveillance: CIGNA may conduct surveillance of you. Surveillance means that CIGNA may hire someone to watch you when you leave your house to see if you do anything inconsistent with disability or inconsistent with what you have told CIGNA. So, for example, if you have you’re your doctor that you cannot grocery shop, it is inconsistent to be videotaped carrying several bags of groceries. Generally speaking, this type of surveillance is unlikely. It happens, but not as often as you may fear. It would be very expensive to conduct surveillance on every person who files a disability claim. What is not expensive is conducting online searches for your activities. For this reason, it is likely that CIGNA conducts online searches for almost every disability claimant. If you haven’t already, it is worthwhile to delete your online social media profiles or make them private. Even if you are not doing anything that is inconsistent with disability, CIGNA may misinterpret the information available online.

What You Should Consider Supplying to CIGNA with Your Claim or Appeal

CIGNA may not ask for everything that it should have to be able to adequately evaluate your disability claim or appeal. For this reason, you need to make sure you do all you can do to supply that information. This is a list of some of the items you should consider submitting.

Personal Statement: Providing personal information, in addition to the information requested on the CIGNA disability application, can help you prove that you meet the definition of disability. You should consider providing information regarding your work history, the history of your conditions and symptoms, the specific duties that you can no longer perform and why, which activities of daily living you can no longer perform (can you still cook, clean, dress yourself, balance a checkbook, etc.), and what your plans for the future are.

Statements of Family Members, Friends, and Coworkers: The statements of other people in your life can help to provide some context and further support for your work history and the history of your conditions and symptoms. The statements can also help humanize you in the mind of the CIGNA reviewers. The subject matters can be similar to the subject matters of your personal statement to the extent that is appropriate. Ask your people to be specific about what they know. Anecdotes help.

Testing Evidence: If imaging such as an MRI or an X-ray is appropriate, make sure those studies are submitted to CIGNA. If your disability relates to your cognitive abilities, consider having a neuropsychological evaluation submitted to CIGNA. If your disability is physical, consider having a functional capacity evaluation submitted to CIGNA.

Report of Your Doctor: Your doctor’s notes may not be as detailed as they should be. Or, your doctor's notes may not address your disability to the extent that would be helpful for your CIGNA disability claim application or appeal. Ask your doctor if they would be willing to supply a report detailing your medical history, the evidence reviewed that is supportive of your disability, what activities of daily living you can no longer perform (if any), and what duties of your work you can no longer perform.

Vocational Evidence: It is important for CIGNA to have an understanding of what duties were required by your job, what duties you can no longer perform, and what duties you are qualified to do. You may consider obtaining a vocation report from a vocation expert outlining each of these areas. Or it may be enough to submit a resume, a job description, a personal statement describing your job, and/or an employer or coworker statement describing your job.

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The Maddox Firm can help you file a short term disability claim, a long term disability claim, or an appeal with CIGNA. You can file a claim or an appeal without the assistance of a law firm, but doing so runs an increased risk of denial. Filing an appeal on your own is even more risky. An appeal is your last chance to submit any evidence in support of your claim. If you have to file a lawsuit later, you will likely be barred from submitting any evidence not submitted with the appeal.


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