O’Ryan Law Firm, on behalf of Plaintiff, Dave C., recently filed a lawsuit against a Cigna subsidiary, Life Insurance Company of North America (LINA), after they wrongfully terminated our client’s long term disability benefits which were paid under a Cigna disability policy. Dave worked for Purdue University as a Health Desk Technical Support Supervisor until he became disabled and eligible for disability benefits under the Cigna policy.
Facts of the Case Against Cigna
After over 18 years of employment at Purdue University, Dave was forced to stop working when he became totally disabled due to Seizure Disorder and the resulting symptoms from this disorder. As you can imagine, seizure disorder can be difficult to prove with objective tests because there are very little signs of the seizures unless they are actually occurring. However, Dave’s treating physicians provided objective medical proof that he was unable to continue working due to his seizure disorder.
By way of history, David was involved in a car accident in 1985, while in the military, and sustained multiple injuries including a broken left leg, left hip dislocation, internal bleeding and a serious head injury. After the accident, he developed seizures due to the head injury and began also experiencing depression as a consequence of the seizures.
In 2015, as a result of the seizure disorder, his depression and anxiety became very severe and it began to affect all aspects of his life. He became reclusive, experienced extreme anxiety traveling to and from work, shopping at the supermarket and leaving the house. He began distancing himself from family and friends wanting to only stay in the safe confines of his home. Moreover, he could not drive due to his seizure disorder which ultimately intensified his need for isolation due to growing fear and anxiety. The symptoms of his seizures made it impossible for him to work or function outside of the home.
David filed an application for long-term disability (LTD) benefits offered through Purdue University’s employee benefit plan, which is insured by Cigna. Cigna approved his application for LTD and after paying his LTD benefits for 12 months, Cigna abruptly terminated David’s benefits. Cigna cited the following definition of “Disability”:
“The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is: unable to perform the essential duties of his or her own occupation, as defined by Purdue. You do not have to be confined to your home, but you must be under the regular care of a doctor.
After Disability Benefits, have been payable for 12 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is:
- unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience, and
- unable to earn 80% or more of his or her Indexed Earnings.
The Insurance Company will require proof of earnings and continued Disability.”
“Limited Benefit Periods
The Insurance Company will pay Disability Benefits on a limited basis during an Employee’s lifetime for a Disability caused by, or contributed to by, any one or more of the following conditions. Once 24 monthly Disability Benefits have been paid, no further benefits will be payable for any of the following conditions.
- Anxiety disorders
- Delusional (Paranoid) disorders
- Depressive disorders
- Drug addiction or abuse
- Eating disorders
- Mental illness
- Stomatoform disorders (psychosomatic illness)
If, before reaching his or her lifetime maximum benefit, an Employee is confined in a hospital for more than 14 consecutive days, that period of confinement will not count against his or her lifetime limit. The confinement must be for the Appropriate Care of any of the conditions listed above”
Lawsuit Filed Against Cigna
O’Ryan Law Firm filed a lawsuit against Cigna claiming that they wrongfully terminated Dave’s disability benefits because his doctors had not released him to return to work and his condition had not improved. Additionally, the seizure disorder is the primary disabling condition prohibiting Dave from successfully returning to work at a job he had held at Purdue for 18 years. Of course Dave would love to return to a job that he enjoyed, and making good money, rather than being stuck at home with little income. As a consequence of the improper termination of benefits, Dave also lost his medical coverage, tuition reimbursement and certain retirement benefits.
The lawsuit alleges that Cigna committed the following wrongful actions against the Dave:
- Cigna breached the provisions of the disability policy
- Cigna caused serious financial and emotional distress due to the termination of long term disability benefits.
- Cigna ignored the statements of Dave’s treating physicians who report that Dave has not improved therefore remains unable to work.
- Cigna failed to provide a reasonable basis for terminating Dave’s disability benefits.
The wrongful actions of Cigna have resulted in some serious financial consequences, not to mention the loss of a significant source of income. Dave seeks a verdict from the jury that requires Cigna to compensate Dave for the unpaid disability benefits that are due, along with all accrued interest, and damages for Cigna’s bad faith refusal to pay the disability benefits owed under the policy.
If you are a Purdue employee and Cigna has wrongfully denied your disability benefits, please immediately contact the O’Ryan Law Firm to discuss your options in obtaining the rightful payment of your disability benefits under your Cigna policy.