An Obvious Fact Is Denied In Attempt To Disability Claim Benefit
One LINA case made its way to Federal Court after an extensive series of appeals and denials through the administrative hearing process. The insurance company took the position that the claimants occupation was not Sales Personnel and that he was therefore not entitled to a higher level of disability benefits that would result if his bonuses and target incentive bonuses were included.
But the man was a sales rep for a big pharmaceutical company and his income was structured specifically with bonuses and targeted incentive compensation bonuses.
LINA/CIGNA sought to reclassify his occupation to minimize his monthly benefits. In Federal Court, the judge ruled that LINA/CIGNA failed to prove that he was not a sales person, and the decision of the Plan Administrator was reversed. The claimant won benefits retroactive to the date that his long term disability benefits would have begun. Hodges v. Life Ins. Co. of North Am
CIGNAs record of trying to deny benefits is nothing new. The corporate culture of disability claim denial and termination at CIGNA/LINA led to a $77 million settlement in 2013 following investigations by insurance commissioners from Connecticut, California, Massachusetts, Pennsylvania and Maine regarding improper denials of long-term disability claims and wrongfully terminated benefit payments. Read more about the corporate culture below.
Medical Support Is Essential For A Cigna / Ny Life Disability Benefit Approval
If you havent been visiting your doctor regularly, or if your doctor takes minimal or incomplete notes about your condition, prognosis, and treatment plan, youre unlikely to be approved for Cigna long term disability insurance benefits. Filing for disability insurance benefits before you see the doctor can also be risky without contemporaneous information on file, the disability insurance carrier has no data on what may be wrong with you, how long it has lasted, or when you first began to notice it.
Treatment And Return To Work Programs
You might have to do treatment or return to work programs physiotherapy, occupational therapy, and psychological therapy, for example. This is more common with long-term disability plans, but can happen in short-term, too. They cant force you to go, but if you dont, they can stop your payments.
So, if you have been getting benefits for a few months, be aware that you might be sent for treatment soon.
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What Are The Elimination Periods For Long
The most common elimination period for long-term disability is 90 days, but the exact terms of the elimination period will be specified in the policy. If short-term disability coverage is available, the effective waiting period before receiving benefits will be relatively short. When a short-term policy is not available, however, employees may have to wait several months with no income before qualifying for long-term benefits. Due to the longer elimination periods, many employees opt for a combination of short-term and long-term disability coverage.
Always Be Aware Of Pre
Though short term disability insurance policies dont generally have pre-existing condition provisions, long-term disability insurance policies do. If your disability stems from an issue youve sought medical attention for before you began claiming disability insurance benefits, you may find it challenging to prove that this condition wasnt pre-existing and youre therefore entitled to benefits under the disability insurance policy. Read your disability insurance policy carefully to determine whether a pre-existing condition provision applies if it does, youll need to document your medical visits and treatments even more carefully to differentiate your current disability from any conditions for which youve sought treatment in the past.
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Whats The Elimination Period
While short term disability insurance begins paying benefits within a couple weeks following a qualifying illness or injury, long term disability insurance requires a longer waiting period, called an elimination period, before a policyholder begins receiving benefits. The length of the elimination period varies by policy but is often around 90 days. When considering a disability policy, take into account how you will cover your expenses during the elimination period. Do you have an emergency fund to cover your lost income and any medical bills you accrue during this time? If not, you may consider purchasing additional coverage to protect you immediately following a disabling illness or injury.
Rehabilitation And Returning To Work
Employees and supervisors will need to work together with a Corporate Advisor and an occupational health nurse or an injury recovery specialist to achieve the best outcome. Options include modified job duties, reduced hours, or retraining and finding an alternate job if an employee is permanently medically prevented from returning to their own job.
Plan a trial period with your support team for a gradual return to work to readjust and build up endurance. Employees are paid for hours worked during the trial and will continue to receive LTD benefits for hours not worked. If you have questions about your pay, contact AskMyHR by submitting a service request using the categories Myself My Team or Organization > Pay > Salaries & Other Wages.
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Can You Help With A Cigna Disability Insurance Policy
Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Cigna. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Cigna.
How Do You File For Short
If you believe that youll need to take advantage of your short-term disability benefit, your first step is to make sure that your illness or injury is well-documented, as youll have to provide some medical evidence or backing.
Consult with your doctor and find out what youre up against first. Make sure you speak honestly about your symptoms and the things that you are experiencing. That medical record will be reviewed by an insurance company, so start out with a strong pronouncement of, Hey, Im having this problem, advises McDonald.
Then, approach your HR department to begin the process of filing a claim . Dont have an HR department? Connect with your manager or consult your plan documents to understand exactly what you need to do to submit your claim.
Be aware that short-term disability plans have a requirement for how many days you need to be out of work before you can claim disabilityits called an elimination period. The reason is that they dont want to invoke short-term disability for something that could be covered by sick days, says Bartolic.
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Using A Paaf To Misrepresent Your Functional Capacity
Any Long Term Disability carrier is going to deny your claim that there is medical evidence that you can work at least sedentary capacity. Sedentary is basically loosely defined as work that can be done sitting down, but which may involve standing and sitting, and upper body motion. CIGNA will take the medical records and cherry-pick them so that they can conclude that you can work in at least a sedentary capacity. Then they march blindly to a decision to terminate your benefits and, only after the fact, with one push justify their wrong decision.
Why Do I Need A Cigna Long Term Disability Insurance Claims Law Firm
When you file a long-term disability claim with CIGNA, you can expect there to be some challenges. For starters, you willl want to be very careful about getting your treating doctor on board with gathering all of your medical records prepared to demonstrate more than a diagnosis but HOW and WHY you are impaired. Their response to your CIGNA long-term disability claim could make the difference between an approved claim and one that is denied. See the testimonial from one of Frankel & Newfields CIGNA clients below concerning doctors records and how easy it is to make one mistake that can erase your disability insurance.
Youll also want to be very careful about documenting your contact with any CIGNA representatives. Every time you have an interaction with a representative from the company, or from one of the many subcontractors that CIGNA hires to investigate claims, take detailed notes. Here are some of the people who might contact you directly at CIGNAs direction:
- Claims adjusters
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How To File A Disability Claim
1Programs are provided through third party vendors who are solely responsible for their products and services. Full terms, conditions and exclusions are contained in the applicable client program description, and are subject to change. Program availability may vary by plan type and location, and are not available where prohibited by law.
2These programs are NOT insurance and do not provide reimbursement for financial losses. Some restrictions may apply. Employee assistance services are provided by or through Cigna Behavioral Health, Inc. Customers are required to pay the entire discounted charge for any discounted products or services available through these programs. Programs are not available under policies issued by New York Life Group Insurance Company of NY.
3My Secure Advantage is NOT insurance and does not provide reimbursement for financial losses. Program is provided through a third-party vendor who is solely responsible for their products and services. Program is not available under policies issued by New York Life Group Insurance Company of NY.
New York Life Group Benefit Solutions products and services are provided by Life Insurance Company of North America and New York Life Group Insurance Company of NY, subsidiaries of New York Life Insurance Company.
Life Insurance Company of North America is not licensed in New York and does not conduct insurance business in New York.
This material and page are not intended for use with residents of New Mexico.
Tips For Completing The Cigna / Ny Life Disability Claim Forms
You or your attorney will need to fill out some abbreviated disability insurance claim forms. Because these disability insurance forms generally allow for just a couple of handwritten lines for each question, its often beneficial to use attachments or addendums to set the facts out in greater detail and provide a more complete picture. After receiving the forms, the insurance carrier may reach out to the claimant, the doctor, or anyone else who is involved in the matter to confirm or clarify information in the disability claim form.
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Video Surveillance By Cigna
Insurance companies do hire private investigators to conduct video surveillance, and Cigna is no exception. Surveillance may include following you for the entire day while you are on your daily errands, following you to doctors appointments, parking outside your house, and recording you. Long Term Disability claimants should exercise extreme caution when interacting with anyone they suspect to be an investigator. If you are observed participating in activities that are inconsistent with your medical impairments, the insurance company may find that your condition has improved and may discontinue your benefits.
Cigna: Advice For The Difficult Cigna Ltd Appeal Process
New York Life Insurance Company has acquired Cigna Group Insurance, which is now known as New York Life Group Benefit Solutions. We are already receiving correspondence from New York Life Group Benefit Solutions on behalf of our clients, which states that we should not notice any changes other than the new company name, which will appear in place of Cigna Group Insurance moving forward. Contact information for existing claims, such as phone numbers and mycigna.com remain the same at this time .
Long term disability insurance is intended to protect an employee from the loss of income in the event that he or she is unable to work for an extended period of time due to a disabling illness, injury, or accident. A Cigna long term disability plan provides that a portion of covered income is replaced and paid directly to the disabled employee. According to some estimates, the average employee with a long term disability misses as much as two and one-half years of work.
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Who Is Eligible For Sdi In California
An employee is eligible for SDI if the employee is unable to work due to a disability and has lost income as a result. Employees are eligible only if they have received at least $300 in wages, from which SDI taxes were withheld, during the base period. The base period is a one-year period, usually ending just before the last complete calendar quarter before the employee filed a claim. For example, if the employee files a claim in April 2021, the base period is 2020. Read more in our article on eligibility for SDI in California.
Note that you cannot collect SDI and temporary disability benefits from Californiaâs workersâ compensation program at the same time.
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What To Do If Cigna Denies Your Claim
If Cigna decides to deny your benefits claim, you will be notified by mail. Your denial notice will tell you why the company denied your claim and how you can appeal its decision. There will be a deadline in your letter by which you must file your appeal. If you miss it, you will not be able to try to recover your benefits from Cigna in the future.
Appealing a Denial from Cigna
If you are denied, you might benefit by getting legal help from the experienced attorneys at Osterhout Berger Disability Law. Your lawyers will want you to ask for a copy of your claim file from Cigna. The file will include all of the evidence that the insurance company used as reasons for denying your claim. Bring your file copy and your letter into our office for your appointment.
After reviewing the information, your knowledgeable lawyer may advise you to do several things. He or she will want to help you to add evidence that is favorable to you to your file. When you add more evidence to your claim file, it will be likelier that you will be successful with your appeal. For this reason, your attorney may tell you to submit to additional evaluations and medical exams. He or she may also want you to get more objective tests such as MRIs, lab tests or x-rays. Finally, your lawyer may ask you to get written statements from your doctor and your acquaintances about the limitations that your condition has on your ability to perform the daily tasks of your life and of your job.
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Is This Topic For You
This topic covers depression in adults. For information on:
- Depression in young people, see the topic Depression in Children and Teens.
- Depression after childbirth, see the topic Postpartum Depression.
- Depression followed by times of high energy, see the topic Bipolar Disorder.
- Depression and suicide, see Depression and Suicide.
How Much Does Cigna Disability Pay
Most policies will pay 60 percent of your insured pre-disability earnings while out due to an approved disability. Most LTD policies do not take effect until after an elimination period, which is typically a six-month waiting period. After the elimination period, if the claimant remains disabled as defined by the policy, then benefits will be paid.
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How Is It Treated
Depression can be treated in various ways. Counseling, psychotherapy, and antidepressant medicines can all be used. Lifestyle changes, such as getting more exercise, also may help.
Work with your health care team to find the best treatment for you. It may take a few tries, and it can take several weeks for the medicine and therapy to start working. Try to be patient and keep following your treatment plan.
Depression can return . How likely you are to get depression again increases each time you have a bout of depression. Taking your medicines and continuing some types of therapy after you feel better can help keep that from happening. Some people need to take medicine for the rest of their lives. This doesn’t stop them from living full and happy lives.
How Long Will You Need Therapy
How long your treatment lasts depends on how severe your depression is and how well you respond to treatment. Short-term counseling or therapy usually lasts from 10 to 20 weeks, and you usually see your mental health professional once a week. But you may need to meet with your health professional more often or for a longer time.
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How To Prepare Your Doctor For A Phone Call From A Cigna / Ny Life Doctor
Doctors often have incredibly hectic schedules, and obtaining a physicians statement that meets your disability insurance carriers needs can sometimes be a challenge. Its worth having a conversation with your doctor to make clear what type of documentation Cigna will need to approve a disability insurance claim. The more you can do to make this process easier on your doctor, the better.
Traversing a long term disability claim with New York Life/ Cigna can be a challenge for anyone. The experienced legal minds at Dell & Schaefer can help. Weve handled hundreds of New York Life/ Cigna claims and know what theyre looking for when it comes to approving benefits. Call 800-682-8331 to set up a FREE consultation to discuss your Cigna claim with Dell & Schaefer.
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