Our client is a 63-year old corporate quality control officer disabled due to diabetes, diabetic neuropathy and chronic nerve pain. CIGNA terminated benefits at the any occupation transition.
CIGNA’s doctor never met our patient; he only reviewed our client’s paper file and never offered an analysis of the medical records. Instead, he based his report on a summary that had been written by the nurse case manager. He ignored abnormalities and clinical findings that were clearly documented in our client’s office visit notes and laboratory test findings.
Additionally, he never considered the large number of prescription medications our client needs to take and the side effects caused by the medicines. Despite the fact that CIGNA’s doctor and our client’s treating physicians were of differing opinions, CIGNA never bothered to have our client examined in person. Instead, it relied on a flawed and selective review of her medical records when it terminated her benefits. We worked with our client’s doctors to refute the selective internal medical records review.
CIGNA also used their own medical review as a basis for their vocational analysis. It did not consider our client’s doctors opinions when determining what her restrictions and limitations were. CIGNA’s vocational analyst selectively picked the information from the claim file which would benefit his transferrable skills analysis (TSA).
He did not consider that the medications our client takes every single day are known to cause extreme fatigue in the afternoons. He also did not consider that our client lives in a state of chronic debilitating pain due to neuropathy and that this chronic pain often causes lapses in concentration. He never evaluated how our client would be able to work full time at a “desk type job” when she is not able to maintain a constant level of concentration due to the chronic pain and the side effects of the medications.
We aggressively argued that the entire transferable skills analysis was inherently flawed because the vocational analyst did not have access to any medical records and made this analysis with no knowledge of our client’s restrictions and limitations that were determined by her treating physicians.
We developed strong support with the assistance of our client’s doctors to show CIGNA that our client remained disabled.
Upon reviewing our appeal, CIGNA determined that our client indeed remained disabled and reinstated her benefits.