CIGNA Reverses Denial of Disability Benefits for Toyota Employee

O’Ryan Law Firm recently filed an appeal for Long Term Disability benefits against Cigna for wrongfully denying a participant’s benefits.  The client was a long-time employee of Toyota, working as a warehouse associate.  She was forced to stop working due to breast cancer, a bilateral mastectomy, and the residual effects of chemotherapy and treatment; including fatigue, migraines, bilateral lower extremity neuropathy and severe pain.

Despite the client’s treating physicians providing objective medical proof that she was unable to continue working due to her condition, Cigna hired a contracted physician to review her claim file.  The contracted physician contended the client could perform a sedentary occupation on a full-time basis even though the client’s own physicians stated she could not work at all.  The treating physicians reported to Cigna that she could not work and never released the client to return to work full-time.

Cigna originally approved the short-term disability and long-term disability claim in full until the time when the definition of Disabled changed to “performing the duties of any occupation.” As soon as this definition kicked in Cigna terminated her benefits.  Cigna’s hired contract physician even agreed with the treatment, limitations and restrictions placed on the client but in order to be hired for another claim file review the contracted doctor opined that the client was able to work a full-time job.  Cigna cited the following definition of “Disability within the long-term disability denial letter:

Cigna’s Definition of Disability/Disabled:

“The Employee is Disabled, if, because of Injury or Sickness, he or she is either:

  • unable to perform the material duties of his or her regular occupation; and
  • unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation

After Disability Benefits have been payable for 24 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is either:

  • unable to perform the material duties of any occupation for which he or she may reasonably become qualified based on education, training or experience; and
  • unable to earn 80 % or more of his or her Indexed Earnings.”

O’Ryan Law Firm submitted a Disability Appeal which included numerous exhibits and medical records further showing that the client remained disabled and entitled to her disability benefits under the Cigna policy.  Our office submitted the appeal on August 29, 2017 and Cigna’s decision to deny our client’s benefits was overturned by Cigna on December 4, 2017.  O’Ryan Law Firm was successful on appeal without the need to pursue litigation saving the client tons of money and time and resulting in the immediate reinstatement of her benefits by Cigna along with the payment of her back benefits from the date her benefits were wrongfully terminated.

Has Cigna denied your disability benefits? If so, contact the Indiana disability lawyers at O’Ryan Law Firm to discuss your rights.