Riemer Hess regularly helps our clients obtain long term disability benefits from Cigna. As one of the largest disability insurers in the U.S., Cigna makes tremendous profits by denying or terminating long term disability benefits. Many of our clients come to us after initially experiencing challenges with Cigna, whether Cigna has denied their claim or wrongfully terminated their benefits.
Below we’ll discuss common tactics Cigna uses to deny disability claims and what strategies work best to secure your benefits from Cigna.
What common tactics does Cigna use to deny disability claims?
Cigna has a long list of tactics that it uses to deny disability claims. In our experience, common tactics that we’ve observed Cigna use include:
- Relying on paper reviewers: Cigna may reject the well-reasoned and well-supported opinion of your treating medical provider(s) in favor of flawed and unreliable reports from their own medical consultants.
- Conducting incomplete medical record reviews: When utilizing paper reviewers, Cigna may neglect to provide the consultant(s) your full file with all submitted medical evidence. This means the consultant renders an opinion based on incomplete information.
- Using "independent" medical examiners: Cigna may enlist an "independent" medical examiner to conduct an incomplete and cursory medical examination, and use the resulting report as reason to deny your claim.
- Ignoring approval of Social Security Disability benefits: The Social Security Administration often has a higher threshold for disability benefit approval. If you are approved for SSDI benefits, the award letter can be used as support for your claim. Cigna may choose to disregard your SSDI approval and deny your benefits regardless.
- Continuously demanding more information, despite having everything it needs to approve a claim: Cigna may drag out the claims process by requiring you to furnish more and more documentation, even when there is enough in the file for them to make a determination.
- Failing to consider the non-exertional demands of your occupation: Your occupation may have high-level cognitive demands you are unable to perform due to your symptoms. Oftentimes Cigna will neglect to consider the cognitive aspect of your job role. Instead, Cigna will assess only your physical functioning when making a determination.
- Attacking your credibility without any sound reason for doing so: Cigna may claim you are malingering or exaggerating your symptoms, even if they have no basis for this allegation, and despite evidence to the contrary.
- Failing to consider the combined impact of your multiple medical conditions: If you suffer from multiple medical conditions, the the complex interactions and potential complications of your conditions may prevent you from working. Cigna may ignore the totality of your symptoms or how your co-morbidity affects your physical and cognitive functioning.
What happens if Cigna denies my disability claim?
Having your disability claim denied by Cigna can be a devastating experience. You’ve paid for long term disability coverage, and then when you need it most, Cigna wrongly decides you aren’t entitled to your benefits. However, a claim denial from Cigna is not the end of the road.
If Cigna denies your long term disability claim and the claim is subject to ERISA, you have the right to appeal its decision. The internal appeals process with Cigna provides you the opportunity to address its justifications for denying your claim and offer new supportive evidence.
It is important to note that this internal appeals process is typically your last shot at avoiding expensive and lengthy litigation. We always recommend speaking to an experienced ERISA attorney who can review your Cigna denial letter and provide guidance on how to best move forward with your appeal.
Have courts criticized Cigna's disability claims handling practices?
If Cigna has wrongly denied your long term disability claim or appeal, you are not alone. Courts across the country have criticized Cigna for its disability claims handling practices.
Here are just a few examples:
- Moar v. Cigna Corp., 2018 WL 2752996, at *3 (E.D. Mich. June 8, 2018): In Moar v. Cigna, the court criticized Cigna for relying on the unsupported, speculative reports of its paper reviewers.
- Sangha v. Cigna Life Ins. Co. of New York, 314 F. Supp. 3d 1027, 1038 (N.D. Cal. 2018): In Sangha v. Cigna, the court criticized Cigna for relying on a three-minute “independent” medical examination performed by Cigna’s doctor in order to deny Sangha benefits.
- Alfano v. CIGNA Life Ins. Co. of New York, 2009 WL 222351 (S.D.N.Y. Jan. 30, 2009): In Alfano v. Cigna, the court criticized Cigna for rejecting the seven well-supported opinions of plaintiff’s treating physicians, and for failing to credit the SSA’s disability determination.
What strategies work best against Cigna?
When filing a long term disability claim with Cigna, the best strategy is a well-planned one. To get ahead of Cigna, Riemer Hess works hard to proactively predict which tactics Cigna is likely to use on any given claim. This can be tricky because each claim presents its own unique set of facts. We apply a combination of our experience with Cigna, together with the unique facts of each claim, to craft a customized strategy designed to win benefits.
For example, our client John was working as an industrial plant manager when he suffered a serious back injury requiring surgery. Even after undergoing a spinal fusion, John continued to experience frequent pain that was greatly aggravated by any physical activity. John could no longer perform his job duties after his injury and had little to no improvement after surgery.
John filed for long term disability through his employer-sponsored policy with Cigna. To his shock, Cigna denied his claim. Cigna had wrongfully classified John’s occupation as “light” and as requiring little physical activity. However, John’s job as a plant manager required extensive time on his feet, often lifting heavy items, and significant time sitting statically at a desk working on a computer.
John retained Riemer Hess to handle his appeal with Cigna. Riemer Hess immediately requested his claim file from Cigna, referred John to undergo a Functional Capacity Evaluation (“FCE”), and went to work gathering evidence of John’s occupational duties and medical disability.
Riemer Hess quickly made a game plan for the appeal: obtaining an official job description from John’s employer outlining his physical job duties that Cigna had ignored, the FCE report, a letter from John’s treating doctor corroborating the FCE results, an affidavit from John providing details on his job role and the onset of his disability, and requesting any medical records John had not submitted with his original claim. Riemer Hess coordinated with the FCE evaluator and John’s treating doctor to make sure their documentation included all relevant and accurate information regarding John’s symptoms, restrictions and limitations, and occupational duties.
Armed with this new evidence, Riemer Hess wrote a comprehensive and detailed appeal letter to Cigna explaining exactly how the evidence supported John’s disability claim and how Cigna had wrongfully assessed the level of physical functioning required for his work. Cigna conceded and overturned their original denial, thereby paying John his back benefit amount and paying him future benefits, as long as he stays in compliance with Cigna’s LTD policy.
John was thrilled with this result and retained Riemer Hess to monitor his LTD claim going forward.
How can an attorney help me win disability benefits from Cigna?
Cigna employs many tactics to deny long term disability claims that should always be taken seriously. Don’t fall into Cigna’s traps. An experienced long term disability attorney can help you avoid common pitfalls and maximize your chances of success. Whether you are filing a long term disability claim, appealing a wrongful denial, or facing litigation with Cigna, the disability attorneys at Riemer Hess can help. We have the experience it takes to beat Cigna. Call Riemer Hess LLC at (212) 297-0700 or click the button below to schedule a consultation on your disability case.