The O’Ryan Law Firm has sued Cigna on behalf of a Subaru employee who became disabled, was paid short term disability benefits but then Cigna denied his long term disability benefits. The client was a Warehouse Associate with Subaru of America for several years. His job at Subaru as a Warehouse Associate included the following responsibilities:
- Reading production schedules, customer orders, work orders, shipping orders and requisitions to determine items to be moved, gathered or distributed.
- Conveying materials and items from receiving or production areas to storage or to other designated areas by hand, hand-truck, or electric hand-truck.
- Sorting and placing materials or items on racks, shelves or in bins according to predetermined sequence, such as size, type, style, color or product code.
- Sorting and storing perishable goods in refrigerated rooms.
- Filling requisitions, work orders, or requests for materials, tools, or other stock items and distributing items to production workers or assembly line.
- Assembling customer orders from stock and places orders on pallets or shelves, or conveying orders to packing station or shipping department
- Marking materials with identifying information, using stencil, crayons or other marking device.
- Opening bales, crates and other containers using hand tools.
- Recording amounts of materials or items received or distributed.
- Weighing or counting items for distribution within plant to ensure conformance to company standards.
- Arranging stock part in specified sequence for assembly by other workers.
This position at Subaru requires frequent stooping, crouching, reaching, handling, fingering, depth perception and occasional climbing and kneeling. Obviously, it is a physical job.
After several years of working at Subaru, the client was forced to stop working because he suffered a left rotator cuff rupture and left bicep tear. He experiences constant severe shoulder and arm pain and tingling. The client applied for short term disability benefits and Cigna approved his short term disability benefits. However, when he remained unable to return to Subaru, after the expiration of his short term disability benefits, Cigna refused to pay him long term disability benefits.
Cigna insures the long term disability benefits for Subaru so they are responsible for paying the long term disability benefits to Subaru employees who are disabled on a long term basis. However, Cigna has a financial conflict of interest because if they approve the claim then they pay the benefits. If Cigna denies the disability benefits, they get to keep the disability payments rather than paying them to the Subaru employee who has become disabled. The Cigna policy for Subaru employees requires Cigna to pay disability benefits if the Subaru 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.”
To deny the long term disability benefits, Cigna relied on their own Associate Medical Director and staff RN at Cigna, neither of whom examined the client or spoke to him. LINA’s RN and Associate Medical Director admitted that the restrictions placed on the client were in agreement with all of his treating physicians; regardless, Cigna refused to pay the disability benefits.
When the claim was denied by Cigna, the client filed an internal appeal with Cigna submitting Attending Physicians’ Statements from both his orthopedic surgeon and orthopedic specialist, both of whom strongly support the claim. Also submitted was EMG testing (nerve conduction testing) confirming cervical radiculopathy, among other things. The client has attempted numerous therapies to treat the chronic pain but he continues to suffer from severe pain and remains unable to return to work at Subaru.
If you are a Subaru employee who has been denied disability benefits by Cigna, contact the O’Ryan Law Firm to find out your rights under the Cigna policy and the law.