O’Ryan Law Firm has sued Cigna on behalf of a Finish Line employee who became disabled. Cigna paid long term disability benefits for one year, and then terminated her benefits. The client worked as an IT Business Relationship Manager at the Finish Line corporate office in Indianapolis. Her job required her to sit for more than 6 hours during her shift, and stand for up to 4 hours at a time periodically. Her average work week was 45-50 hours. It was a very physically demanding job.
The Finish Line is an American retail chain that sells athletic shoes and related apparel and accessories. The company operates 660 stores in 47 states, mostly in enclosed shopping malls, as well as Finish Line-branded athletic shoe departments in more than 450 Macy’s stores. The Finish Line has one of its’ corporate offices located in Indianapolis. The following is a statement from the Indianapolis Corporate Office:
“Finish Line has the latest running shoes, basketball sneakers, casual shoes and athletic gear from brands like Nike, Jordan, Adidas, Under Armour, Puma, Champion and more. We’re committed to providing top-notch customer service and offering a variety of products for men, women and kids so you can find all the shoes, clothing or accessories that you’ve been looking for.”
After working for several years, our client was forced to stop working when she became totally disabled due to the debilitating effects of myalgic encephalomyelitis and postural orthostatic tachycardia syndrome. Myalgic Encephalomyelitis is also known as “Chronic Fatigue Syndrome,” or “ME/CFS,” or even a proposed new label, “systemic exertion intolerance disease.” This disease can sometimes cause intermittent confusion and disorientation. Some symptoms may include debilitating fatigue that is constant or recurring. It’s fatigue like you have the flu or like you are on chemotherapy. Some describe it like having concrete in your body or like having “a dead battery.” After a full night of sleep, patients may not feel that they have slept at all or that they have a hangover. Some may have problems falling asleep or staying asleep. Some take more time to transition from sleeping to awake activity and trouble with thinking abilities. This could include the inability to think quickly, remember things, focusing, processing new information quickly, and sometimes what is described as “brain fog.” It could include the inability to do math or difficulty multitasking. Forgetting words or getting your “wires crossed” is also commonly reported in those with ME/CFS. With orthostatic Intolerance there is a worsening of symptoms while standing or sitting upright. People with ME/CFS may be lightheaded, dizzy, weak, or faint while standing or sitting up. They may have vision changes, such as blurring or seeing spots. Other symptoms that patients may experience include muscle pain, sore throats, swollen lymph nodes, sound and light sensitivity, cold or heat sensitivity, headaches, easily bruising, and vertigo. In all, about 60 different symptoms can occur with the disease, and each patient’s symptom profile may be different.
Our client’s treating physicians provided objective medical proof that she was unable to continue working at Finish Line due to these severe medical conditions. After reviewing her job description, the client’s physician believes that the client suffers from profound neurocognitive difficulties which impairs the client’s ability to perform most of the physical demands of her job. He stated that “no medication or lifestyle intervention has improved her symptoms since they started profoundly affecting her life in early 2017.”
When the client was forced to stop working, she applied for long term disability benefits that were offered through the Finish Line’s employee benefit plan and insured by Cigna. Cigna approved her application and paid her disability benefits through August 22, 2017. On August 25, 2017, Cigna informed her that her benefits would stop. Cigna insures the long term disability benefits for The Finish Line so they are responsible for paying the long term disability benefits to Finish Line employees who are disabled. However, Cigna has a financial conflict of interest because if they approve the claim then they also pay the benefits out of their pocket. If they deny the claim, they keep the disability payments rather than paying them to the disabled Finish Line employee.
The Cigna policy for Finish Line employees requires Cigna to pay disability benefits if a Finish Line employee meets the following definition of Disabled under the policy:
Definition of Disability/Disabled:
The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:
- 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:
- 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.
When the claim was denied by Cigna, the client filed an appeal, but Cigna denied her appeal, even though the client’s doctor provided supporting statements that the client continues to deal daily with headaches, severe fatigue, poor sleep, insomnia, recurrent rashes, intermittent hoarseness, dizziness, and memory/cognitive problems.
If your long term disability benefits have been denied by Cigna, contact the O’Ryan Law Firm to find out your rights under the Cigna policy and the law.