Nick M. hired O’Ryan Law Firm to assist with his appeal for long term disability benefits from Life Insurance Company of North America (“LINA”), a CIGNA company. LINA approved and paid his long term disability benefits claim for seven years. After seven years of paying his disability benefits, and despite having no evidence that his condition had improved, LINA abruptly terminated Nick’s benefits in May 2018. Previously, Nick worked as an Information Analyst with Purdue University for almost ten years before he became disabled. Purdue’s main campus is located in West Lafayette Indiana and is one of the premiere educational institutions for higher education. Purdue offers more than 200 majors for undergraduates, over 69 masters and doctoral programs, and professional degrees in pharmacy and veterinary medicine
LINA is a Cigna corporation whose principal place of business is in Philadelphia, Pennsylvania. Under the LINA policy, Nick is entitled to continue receiving disability benefits if meets the definition of disabled pursuant to the following definition from the policy:
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:
- 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.
Nick worked for Purdue until November of 2010, when he suffered a ruptured brain aneurysm causing a left front subarachnoid hemorrhage and stroke. As a result of his ruptured aneurysm and stroke, Nick suffers significant neurocognitive impairment including difficulties with short-term memory and decreased mental efficiency, processing speed for complex tasks, and verbal fluency. This leaves him unable to perform the complex, detail-oriented work required in his former position as an Information Analyst, or any other gainful occupations in his highly complex and technical field of computer science and informatics.
LINA concedes that Nick does suffer from cognitive inefficiencies, but nonetheless argues that he is not functionally impaired as a result of these cognitive deficits and therefore is capable of working as a computer processing scheduler or systems analyst. Contrary to LINA’s contentions, diagnostic images taken after Nick’s aneurysm and stroke objectively confirm the damage to his brain that causes his cognitive impairment.
A 2011 MRI revealed encephalomalacia, which is the softening or loss of brain tissue after cerebral infarction, cerebral ischemia, infection, craniocerebral trauma, or other injury without underlying lesion due to hemorrhagic stroke, and a 2013 CT scan revealed a chronic area of subtle calcification and mild generalized atrophy of his brain. Associated symptoms commonly include progressive impairment of memory and intellectual function that is severe enough to interfere with social and work skills, seizures, and disturbances in speaking and understanding language, and small vessel ischemic change. Further proof of Nick’s cognitive impairment was provided in the form of a 2014 neuropsychological evaluation performed by Dr. Renee Nevins a licensed psychologist who evaluated Nick and concluded that he suffered from cognitive impairments resulting from his aneurysm, stroke, and medication side effects that impair his ability to learn new information and understand complex, multiple step instructions.
In addition to the aneurysm and stroke, Nick suffered from renal failure dating back to approximately 2008. Although he was finally able to undergo a kidney transplant, he continues to suffer from complications of his renal disease, as well as side effects from his post-transplant medications.
When LINA terminated the disability benefits, Purdue automatically terminated his other benefits including medical coverage, dental and vision coverage, life insurance coverage and monthly retirement deposits. Fortunately, LINA and Nick agreed to mediate the case with a neutral third party mediator. Through the mediation process, and subsequent negotiations, LINA and Nick agreed to settle the case and dismiss the litigation.
If you are a Purdue employee who needs help with a Cigna long term disability claim, please call the O’Ryan Law Firm for further assistance.