Our client contacted us after CIGNA denied a claim for long term disability insurance benefits for a psychiatrist based on the results of an IME – Independent Medical Exam – that claimed that he was cable of performing sedentary work. The doctor who conducted the IME was of course generously paid by CIGNA and we are confident that he does many similar exams on their behalf.
Our client suffers from serious orthopedic disabilities, including cervical degenerative disc disease, thoracic degenerative disc disease, lumbar degenerative disc disease, cervical spine stenosis, osteoarthritis of the basilar thumb joints and bilateral carpal tunnel syndrome, all of which are made worse by fibromyalgia, chronic myofascial pain syndrome and depression. His medical records thoroughly document his disabilities, and there is regular on-going medical care.
How then, in the face of such a medical diagnosis, could CIGNA deny him? The doctor performing the IME stated that the psychiatrist was able to perform sedentary work.
We attacked the denial with the help of the client’s treating doctor, who wrote a powerful rebuttal. We also emphasized the cognitive aspects of our client’s profession as a psychiatrist, which was completely and conveniently overlooked by the report. While our client’s disability may have been physical in nature, severe chronic pain rendered him incapable of maintaining the intense focus and concentration needed to perform the specific duties of his profession. We won the appeal, and he is on claim.