Disability Insurance Blog

CIGNA’S Wrongful Denial Is Overturned By Frankel & Newfield

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Wednesday, April 1st, 2009

Our client worked for one of the largest hotel and timeshare corporations in the world as a Director of Sales and was responsible for over $1.5 million in revenue each year for the company.

Our client went out of work in late 2008 due to morbid obesity, Dyspnea with exertion, extreme fatigue, severe obstructive sleep apnea, difficulty walking, trouble sleeping, major depressive disorder, obsessive-compulsive disorder, mitral insufficiency, concentric left ventricular hypertrophy, trivial tricuspid insufficiency, and atrial arrhythmias.

When he went out of work, our client was literally unable to walk more than a few feet without experiencing shortness of breath and numerous pains throughout his body.

Our client filed for long term disability benefits with his insurance company, CIGNA, and was denied on the basis of CIGNA’s erroneous conclusion that he was capable of performing full-time sedentary work.

After learning of this denial, our client hired our firm to submit the appeal on his behalf.

In denying the client’s initial long term claim, CIGNA conducted a selective paper review of our client’s medical records; and, instead of appreciating the requirements of his specific job, CIGNA used the generic job description of a light-duty sales person.

We worked with our client to ensure that CIGNA had all of the most current medical records, test results, and a copy of the client’s actual job description. All of this information was included with the appeal, and we successfully demonstrated to CIGNA that our client suffered from numerous co-morbid conditions that were supported with objective evidence and that these co-morbid conditions must be taken into consideration as such, not in isolation from each other.

Based upon all of the information submitted in the appeal, our firm was successful in having CIGNA overturn their original decision and the client’s benefits were awarded to him.