O’Ryan Law Firm, on behalf of Plaintiff, Jennifer D., recently filed a federal lawsuit against Life Insurance Company of North America (LINA), a subsidiary of CIGNA. Jennifer was a classroom teacher, responsible for providing instructional services necessary to educate all students to high standards and ensure that all students meet internationally benchmarked Common Core Standards linked to Indiana’s Academic Standards. Jennifer was forced to stop working when she became disabled due to chronic pain as a result of occipital neuralgia, trigeminal neuralgia, cervical facet arthropathy, and neuropathic pain. Trigeminal neuralgia is a hideous medical condition which causes severe facial pain with no known effective treatment. According to the American Association of Neurological Surgeons, trigeminal neuralgia is described as follows:
Trigeminal neuralgia, also known as tic douloureux, sometimes is described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face.
Jennifer tried pain management, physical therapy, chiropractic care, massage therapy, medication changes, injections, surgeries, etc. to alleviate her pain with no success. An MRI of Jennifer’s brain showed left occipital craniotomy and mild atrophy of the left cerebellar hemisphere.
When Jennifer was forced to stop working, she applied for Long Term Disability (“LTD”) benefits offered through the Fort Wayne Community School Corporation’s employee benefit plan, which is insured by Cigna. Cigna approved her application for LTD benefits and paid her from December 13, 2014-October 12, 2016. However, on December 23, 2016 Cigna abruptly terminated her benefits claiming, “Because no restrictions and/or limitations were medically supported for either your mental or physical conditions, it was determined that you would be able to perform your Regular Occupation.” Cigna cited the following definition of “Disability”:
“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 60 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, experience; and
- Unable to earn 60% or more of his or her Indexed Earnings from working in his or her Indexed Earnings.
The Insurance Company will require proof of earnings and continued Disability.”
In support of Jennifer’s continued disability, Dr. Daniel Roth, Jennifer’s pain management specialist, offered the following statement: “Jennifer is a very unfortunate woman who has suffered with chronic pain for years. Her current diagnoses are: cervical facet arthropathy, myofascial pain syndrome, occipital neuralgia, trigeminal neuralgia, left shoulder pain, chronic pain syndrome, and long term opiate use. In my opinion, this patient has met her maximum medical improvement and is considered totally and permanently disabled. Jennifer should really be considered for long term disability due to her current diagnosis and her functional inability to work. Her level of chronic pain and concomitant decrease in function makes it more medically likely, than not, that she will not be able to maintain meaningful employment.”
Dr. David Moran, Jennifer’s primary care physician, concluded that Jennifer is disabled from performing the material duties of her own occupation as a teacher due to her illnesses. Dr. Moran explained, “Trigeminal neuralgia causes debilitating pain and often triggers worsening anxiety with panic attacks. Pain exacerbated/triggered by temperature changes, wind, barometric pressure changes, stress, elevated heart rate, facial injury/irritation, etc. Flare ups at times unpredictable with varying intensity.” Dr. Moran believes Jennifer’s prognosis for recovery is doubtful but Jennifer remains hopeful with new procedures and technology always developing.
Cigna ignored these statements from Jennifer’s treating physicians and failed to take them into account when terminating her disability benefits. Jennifer was therefore forced to file a lawsuit seeking her disability benefits and damages for Cigna’s violation of Indiana’s covenant of good faith and fair dealing. The parties were able to reach an amicable resolution of the case early on in the litigation.
Contact the O’Ryan Law Firm as soon as possible if your disability benefits have been terminated by Cigna.
1http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Trigeminal-Neuralgia (last viewed on June 19, 2017)