Purdue Employee Sues Cigna

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

Mr. R’s Internal Medicine physician completed an Attending Physician Statement and noted that Mr. R had been referred to a pulmonologist, gastroenterologist, cardiologist, and a rheumatologist.

In further support of Mr. R’s claim, he was approved for Social Security Disability Insurance, which has higher requirements than Cigna’s definition of disability. Mr. R’s SSDI file arrived at the Disability Determination Bureau on December, 10, 2013 and a favorable decision was made 42 days later without going before an Administrative Law Judge.  The speediness of the SSDI approval is almost unheard of in the SSDI world.

Initially, Cigna approved Plaintiff’s claim for LTD benefits on September 27, 2013 for the period of November 20, 2013 to August 27, 2016. On July 28, 2016, Cigna terminated Plaintiff’s LTD benefits beyond August 27, 2016 claiming, “You no longer meet the definition of disability.” In the July 28, 2016 termination letter, Cigna cited the following definition of “Disability”:

“The employee is considered Disabled if, solely because of Injury or Sickness, he or she is: 

  1. Unable to perform the material duties of his or her Regular Occupation; and
  2. Unable to earn more than 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation.

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:

  1. 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
  2. Unable to earn more than 80% or more of his or her Indexed Earnings.” 

Because the Plaintiff was an employee of Purdue University, his disability claim is exempt under ERISA and he has therefore filed a breach of contract and bad faith action against Cigna.  The O’Ryan Law Firm is actively litigating the disability claim on behalf of the Plaintiff with the goal of restoring the disability benefits that their client is entitled to under the terms of the Cigna policy.  If you are a former Purdue employee whose benefits have been denied by Cigna, please contact the O’Ryan Law Firm as soon as possible to discuss your rights under the law.