Articles Posted in Cigna

O’Ryan Law Firm, on behalf of our client, recently settled an accidental death insurance claim filed against Cigna, and the client’s employer, after Cigna refused to pay her accidental death insurance claim upon the accidental death of her husband.  The insurance coverage was purchased through her employer and insured by Cigna.  Shortly after she was hired, our client Ms. Y enrolled in accidental death insurance coverage for her husband through her employer and paid the premiums for the coverage through payroll deductions.

Unfortunately, several weeks after she started her new position, Ms. Y’s husband was killed in a traffic accident when he was struck by multiple motor vehicles while attempting to cross the street.  After her husband’s death, Ms. Y completed and submitted all paperwork provided to her by her employer in order to submit a claim to Cigna under the group accidental death insurance coverage which she had been paying for through payroll deductions.  Cigna denied Ms. Y’s claim, contending that her husband had died before our client was considered to be in a “Covered Class.”  She was never told that there was a 90-day waiting period for the accidental death benefits coverage to begin and nowhere in her company’s handbook and recruiting materials does it mention a waiting period for accidental death benefits coverage.

Despite everything that indicated our client was properly enrolled in the accidental death insurance coverage, Cigna denied her claim, contending that she was not eligible for the coverage because of an alleged 90 day waiting period found in small print in a multiple page insurance policy that was never given to our client.  Apparently only Cigna was aware of this alleged 90 day waiting period, because the employee relations manager and other employees were baffled by the reason Cigna had denied the claim.

O’Ryan Law Firm, on behalf of a former employee of Purdue University recently filed a lawsuit against Cigna for wrongfully denying the former Purdue employee’s disability claim.  The plaintiff had was a long time employee of Purdue, worked at Purdue for over 32 years, until he became unable to continue working in May 2013 due to chronic respiratory failure, cardiomyopathy,  recurrent pneumonia, atrial fibrillation, bronchial asthma, and osteoarthritis.  The Purdue employee’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these this combination of symptoms.  Cigna originally approved the claim but then terminated his benefits contending that the Plaintiff could return to work.

Prior to Cigna’s termination of the Plaintiff’s long term disability, a Functional Capacity Evaluation was performed that actually showed that he was unable to return to work. The functional capacity report states, “Mr. R has been off work since 2013 after developing problems with lung infections and difficulty breathing. He shows fair static muscle strength in the lower extremities when seated, however, is unable to functionally use his legs on stairs, working off the floor, getting to the floor, sustained walking and standing. Mr. R. showed a consistent standing limit to 2 minutes at a time.” Throughout the exam, Mr. R demonstrated using a cane to walk, labored breathing and slight wheezing, along with needing to rotate positions and taking multiple breaks. The physical ability assessment concluded Mr. R is only able to stand two minutes at a time, rarely able to walk, and rarely able to lift/carry 0-10lbs.

Under video surveillance conducted by Cigna on 3 separate days, there was no activity on the 1st and 3rd days, and when the Plaintiff was observed, he used a cane when walking

The University of Notre Dame is a Catholic research university located near South Bend, Indiana. Notre Dame’s Catholic character is reflected in its commitment to the Catholic faith, numerous ministries funded by the school, and the architecture around the campus. Notre Dame rose to national prominence in the early 1900s for its Fighting Irish football team, especially under the guidance of the legendary coach Knute Rockne and is well known for “Touchdown Jesus.”

Cigna is an American worldwide health services organization, whose policies are underwritten by Life Insurance Company of North America (“LINA”). Cigna’s insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups.

In June 2015, U.S. health insurer Anthem Inc. announced an offer to acquire Cigna for more than $47 billion in cash and stock. Anthem confirmed it had reached a deal to buy Cigna on July 24, 2015.

Cigna/LINA provides disability coverage to Notre Dame University employees. Cigna disability claims by Notre Dame employees are exempt from the Employee Retirement Income Security Act because the disability plan is considered a “church plan”; therefore, the lawsuit is filed under state law with breach of contract and bad faith counts.
Continue reading

O’Ryan Law Firm, on behalf of Plaintiff Laura McKenzie, recently filed a federal lawsuit against Life Insurance Company of North America (“LINA”), which is a subsidiary of Cigna Corporation. The Plaintiff was employed as a Registered Nurse with Allied Physicians, which made her eligible for disability benefits under the Allied Physicians, Inc. Long Term Disability Plan (the “Plan”).

In Laura McKenzie v. Life Insurance Company of North America and Allied Physicians, Inc. Long Term Disability Plan, the Plaintiff filed a lawsuit to gain the long-term disability benefits she was entitled to under the terms of the Plan.

Facts of the Case Against LINA

Plaintiff was employed by Allied Physicians, Inc. as a Registered Nurse until she became disabled in 2009 due to the disabling effects of cervical and lumbar spondylosis and other serious medical conditions. Plaintiff filed an application for long term disability benefits and was paid disability benefits by the Allied Physicians, Inc. Long Term Disability Plan from October 2014 to October 2016. LINA issued the disability policy that provided disability coverage to the employees of Allied Physicians.
Continue reading

O’Ryan Law Firm, on behalf of Plaintiff, Pamela H., recently filed a federal lawsuit against Life Insurance Company of North America (LINA) (a subsidiary of Cigna). The Plaintiff was employed by Purdue University, which made her eligible for Purdue’s long-term disability plan, which was insured by LINA.

In Pamela H. v. Life Insurance Company of North America, the Plaintiff filed a disability lawsuit to gain the long-term disability benefits she deserved under the terms of the LINA policy.

Facts of the Case Against LINA

Plaintiff was employed by Purdue University from December 2004 until she became disabled on July 6, 2014 and unable to work. This was due to lumbar radiculopathy and rheumatoid arthritis. Plaintiff’s treating physicians provided objective medical proof that the Plaintiff was unable to continue working due to these ailments.

Plaintiff filed an application for long-term disability benefits and LINA denied her claim on November 3, 2014.
Continue reading

Toyota Motor Manufacturing Indiana, Inc. is an automobile manufacturing factory located in Gibson County, Indiana, in Princeton, Indiana. The closest biggest city is Evansville, Indiana. Toyota Indiana is owned by Toyota Motor Corporation of Japan.

The plants for Toyota Motor Manufacturing Indiana were built in 1996 in order to begin production of a full-size pickup truck solely for the U.S. Market. Toyota Indiana began production of the Tundrabegan in 1999 and Sequoia production began a year later for the 2001 model. Both the Tundra and the Sequoia were new to the market and have only been sold in North America. In 2009, Toyota Indiana began manufacturing the Highlander.

There are approximately 4500 employees of Toyota Indiana. At the O’Ryan Law Firm, we have represented numerous former Toyota employees who worked for many years at Toyota and then were forced to go out on disability when their medical conditions prevented them from working. The Toyota Motor Mfg. North America Long Term Disability Plan is an employee benefit plan administered in southern Indiana. The Long Term Disability Plan promises to provide Toyota Motor Manufacturing employees, as part of an employee compensation package, income replacement benefits in the event an employee becomes unable to work due to sickness or injury. All employees of Toyota are participants in the Long Term Disability Plan and therefore eligible to receive long term disability benefits if their doctor confirms that they are unable to work.

Cigna, or more specifically Life Insurance Company of North America (“LINA”) insures the long term disability coverage to participants of the Toyota long term disability Plan. LINA is an insurance company incorporated and headquartered in Pennsylvania and doing business in the State of Indiana. The Cigna (LINA) policy promises to pay disability benefits to employees of Toyota if they are unable to work due to sickness or injury.
Continue reading

At the O’Ryan Law Firm, we have represented several individuals in disability claims who suffer from a disabling disease called Scleroderma. According to the American College of Rheumatology:

WHAT IS SCLERODERMA?
Scleroderma (also known as systemic sclerosis) is a chronic disease that causes the skin to become thick and hard; a buildup of scar tissue; and damage to internal organs such as the heart and blood vessels, lungs, stomach and kidneys. The effects of scleroderma vary widely and range from minor to life-threatening, depending on how widespread the disease is and which parts of the body are affected.
The two main types of scleroderma are:

• Localized scleroderma, which usually affects only the skin, although it can spread to the muscles, joints and bones. It does not affect other organs. Symptoms include discolored patches on the skin (a condition called morphea); or streaks or bands of thick, hard skin on the arms and legs (called linear scleroderma). When linear scleroderma occurs on the face and forehead, it is called en coup de sabre.

• Systemic scleroderma, which is the most serious form of the disease, affects the skin, muscles, joints, blood vessels, lungs, kidneys, heart and other organs.

HOW IS SCLERODERMA DIAGNOSED?
Diagnosis can be tricky because symptoms may be similar to those of other diseases. There is no one blood test or X-ray that can say for sure that you have scleroderma.
To make a diagnosis, a doctor will ask about the patient’s medical history, do a physical exam and possibly order lab tests and X-rays. Some symptoms he or she will look for include:

• Raynaud’s phenomenon. This term refers to color changes (blue, white and red) that occur in fingers (and sometimes toes), often after exposure to cold temperatures. It occurs when blood flow to the hands and fingers is temporarily reduced. This is one of the earliest signs of the disease; more than 90 percent of patients with scleroderma have Raynaud’s. Raynaud’s can lead to finger swelling, color changes, numbness, pain, skin ulcers and gangrene on the fingers and toes. People with other diseases can also have Raynaud’s and some people with Raynaud’s do not have any other disease.

• Skin thickening, swelling and tightening. This is the problem that leads to the name “scleroderma” (“Sclera” means hard and “derma” means skin). The skin may also become glossy or unusually dark or light in places. The disease can sometimes result in changes is personal appearance, especially in the face. When the skin becomes extremely tight, the function of the area affected can be reduced (for example, fingers).

• Enlarged red blood vessels on the hands, face and around nail beds (called “telangiectasias”).

• Calcium deposits in the skin or other areas.

• High blood pressure from kidney problems.

• Heartburn; this is an extremely common problem in scleroderma.

• Other problems of the digestive tract such as difficulty swallowing food, bloating and constipation, or problems absorbing food leading to weight loss.

• Shortness of breath.

• Joint pain.

HOW IS SCLERODERMA TREATED?
While some treatments are effective in treating some aspects of this disease, there is no drug that has been clearly proven to stop, or reverse, the key symptom of skin thickening and hardening. Medications that have proven helpful in treating other autoimmune diseases, such as rheumatoid arthritis and lupus, usually don’t work for people with scleroderma. Doctors aim to curb individual symptoms and prevent further complications with a combination of drugs and self-care.
Continue reading

Cigna, headquartered in Bloomfield, Connecticut, is a global health services organization and its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. CIGNA is one of the top health insurers in North America, with medical plans covering nearly 12 million people. Cigna operates in 30 countries, has approximately 40,000 employees and manages around $54 billion in assets.

CIGNA is the parent company of Life Insurance Company of North America. Life Insurance Company of North America (“LINA”) offers group life, accident, and disability insurance to employers. LINA was formed in 1956 by Insurance Company of North America (INA), a CIGNA predecessor company. LINA provides group disability insurance to many employers across Indiana including Toyota, the University of Notre Dame, State Farm, Sony Electronics, Covance and many others. Employees of these companies are provided short and long term disability benefits if they become unable to work due to injury or illness. LINA is responsible for processing the claims and making monthly benefit payments if the claimant proves that they are disabled and unable to return to their own occupation.

During the claims process, LINA will have a Nurse Case Manager review the medical records to determine whether an individual meets the definition of Disabled under the terms of the policy. If necessary, the Nurse Case Manager will escalate the review to a Cigna Medical Director who is an employee of Cigna. The Medical Director will also review the medical records and reports to determine whether the restrictions and limitations listed by the claimant’s treating physician are supported by the medical records. It is not uncommon for the Nurse Case Manager and Cigna Medical Director to disagree with the treating physician and to find that the claimant is able to return to work despite the medical evidence supporting the claim.
Continue reading

One of the most disabling symptoms for our disability clients at the O’Ryan Law Firm is chronic, severe pain. The type of pain that keeps you awake most of the night or forces you to lay down most of the day in order to alleviate the pain just a little bit. The pain that results from degenerative disc disease, fibromyalgia, neuropathy and failed back surgeries among other medical conditions. Disability insurance companies are loath to pay disability benefits when the most significant symptom is disabling pain. Oftentimes, the insurance company will discount considerable evidence that the chronic pain is a significant factor in the disability claim because many of the objective medical testing is “normal.” There are no x-rays, MRIs or CT scans that are able to document chronic, severe pain. However, many courts have held that a disability claimant can prove the severity of their pain by showing, with their medical records, repeated attempts to treat the pain including steroid injections, prescription medications, surgery, physical therapy and acupuncture. These treatment methods can show that a claimant is suffering from severe pain.

In this area, when there is an absence of testing to establish the source of pain, a claimant can show that they are disabled by chronic pain by proving that the claimant has diligently sought out treatment for the pain. The Seventh Circuit Court of Appeals has held that “medical science confirms that pain can be severe and disabling even in the absence of ‘objective’ medical findings, that is, test results that demonstrate a physical condition that normally causes pain of the severity claimed by the [plaintiff].” Carradine v. Barnhart, 360 F.3d 751, 753 (7th Cir.2004). Thus, while objective medical evidence must support a finding of an underlying impairment, subjective evidence can be used to demonstrate that the pain associated with that condition is disabling. Carradine, 360 F.3d 753; see also Hawkins v. First Union Disability Plan, 326 F.3d 914, 919 (7th Cir.2003) “Taken in the light most favorable to the plaintiff, the evidence of [plaintiff’s] repeated attempts to seek treatment for his condition supports an inference that his pain, though hard to explain by reference to physical symptoms, was disabling.” Diaz v. Prudential Ins. Co., 499 F.3d 640, 645 (7th Cir. 2007). In Sandell v. Prudential Ins. Co., 2007 WL 4404487, *7 (S.D. Ind. Dec. 13, 2007), the court found that a record review commissioned by the plan administrator was not persuasive, in large part because the reviewing physician failed to consider the claimant’s subjective pain symptoms or address whether the claimant’s pain made it impossible for the plaintiff to hold full-time gainful employment. Similarly in Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management, 693 F. Supp.2d 856, 866 the Court held:

The record here also shows that Gessling aggressively pursued for several years a range of therapies for his pain, including the rhizotomies, acupuncture, epidural injections, and even hypnosis. Those efforts are hard to reconcile with a theory that Gessling was exaggerating or lying about his pain. See Diaz v. Prudential Ins. Co. of America, 499 F.3d 640, 646 (7th Cir.2007) (reversing summary judgment for plan under de novo review; efforts at therapy supported credibility of claimant’s complaints of pain); Carradine v. Barnhart, 360 F.3d 751, 755 (7th Cir.2004) (remanding denial of Social Security disability benefits based on subjective pain complaints where claimant had undergone extensive, varied, and intrusive pain therapies).

If your short term or long term disability benefits have been denied or terminated chances are high that the insurance company has utilized a record reviewing physician to review your medical records and conclude that you are not disabled, without having ever examined you in person. The utilization of record reviewing physicians has become the favorite tactic to deny claims by many of the disability insurance companies such as Cigna, Prudential, Hartford, Sedgwick, Liberty Mutual, Unum and Lincoln Financial. For many of our clients, there are significant medical records and reports from their treating physicians supporting their disability claim yet the insurance company denies the claim because a doctor, who never spoke to or examined the client, says that the client is not disabled and can return to work.

Over the past few several years, the courts have become less tolerant of claims administrators utilizing a bunch of record reviews to deny legitimate claims. Two recent cases from the Southern District of Indiana followed this trend and rejected the opinions of several record reviewing physicians while reversing the denial of benefits. In Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Management, 693 F. Supp.2d 856 (S.D. Ind. 2010), Judge Hamilton held that three paper reviews were insufficient to overcome the medical records and reports from the plaintiff’s treating physician. Specifically, Judge Hamilton found:

At the very least, a mere record review is not sufficient to provide a reasonable basis for discounting Dr. Walker’s and Gessling’s accounts of his pain and resulting limitations. The court does not mean to suggest that it is reviving any requirement of special deference to a treating physician. Far from it. See Nord, 538 U.S. at 825, 123 S.Ct. 1965 (holding that ERISA does not require plans to provide such deference). But to disagree with an apparently sound opinion of a treating physician, a plan administrator needs something much more solid than the consulting physicians provided in this case. See id. at 834, 123 S.Ct. 1965 (reminding courts that plan administrators may not arbitrarily refuse to credit a claimant’s reliable evidence, including opinions of a treating physicians). The medical records did not show that Dr. Walker and Gessling must have been correct–the problems of subjective pain and resulting limitations are difficult to evaluate based on records alone. But after reviewing the records, the reviewing physicians failed to come to grips with the real problem, the whole person, and the history that corroborated his complaints of pain. For these reasons, the records reviews in this case did not provide a reasonable basis for denying the disability insurance benefits for which Gessling and his employer paid substantial premiums to Hartford Life.