We were contacted by a 60-year-old Contracts Manager and Attorney at a world leading project development and construction group who had enjoyed a successful and rewarding career until her illness made it impossible for her to work. After initially accepting her claim, CIGNA thereafter wrongfully terminated her short-term claim, despite no change in her condition, and we were retained to get her benefits back on track.
She suffered from the debilitating effects of chronic migraine and its accompanying symptoms, including head pain and pressure, fatigue, malaise, dizziness, vertigo, tinnitus, visual disturbances, constipation, neck and back pain, sleep disturbances, heat and cold intolerance, brain fog, and cognitive impairment that undermined her concentration, language function and ability to think clearly.
Her position required her to perform multiple complex tasks at a high level of cognition, but she was so debilitated by her illness that she couldn’t perform simple domestic chores.
She retained Frankel & Newfield to fight for her wrongfully terminated disability insurance claim, develop an effective appeal and get her benefits paid and support her long-term disability claim. The challenge was to secure her short-term claim so that her long-term claim could be supported and that claim accepted.
Generally speaking, chronic migraine is a difficult condition to prove, but in this case, she had a significant amount of medical evidence, including the support of a neurologist.
CIGNA’s termination of her claim was disgraceful, ignoring all of the consistent medical proof and instead taking the position that because she was being seen through telemedicine, the medical care she received did not rise to the level of a significant disability. She is one of millions of Americans who were forced to receive care via telemedicine during the COVID pandemic.
We worked closely with our client and her neurologist to develop a powerful appeal of her short-term disability claim, while developing ongoing support for her long-term disability claim. This included having her undergo neurocognitive testing, which revealed a number of deficits in her functioning capacity. We were able to tie this into her vocational requirements to demonstrate her inability to perform the material tasks and duties of her occupation.
We also worked with her treating physician to develop powerful support for her claim and to rebut the evidence developed by CIGNA and its team of medical personnel. We engaged a vocational expert to develop an in-depth analysis of why our client was not able to engage in her occupation, supported by medical evidence.
After reviewing our appeal, CIGNA made numerous efforts to negate the consideration of the issues, including a series of hired gun doctors from biased third-party reviewers. CIGNA also sought to engage in conduct which we revealed to be problematic, including reliance upon unqualified and biased doctors, and failing to address concerns raised about the claim handling process. We did not give up, maintaining our client’s disability status and aggressively fighting back on her behalf – writing numerous post-appeal letters to CIGNA to further buttress her claim.
After four further submissions on appeal, CIGNA relented and determined that it would pay the claim and reverse its decision. She received her short-term disability benefits, and we continue to work with her to ensure that her long-term disability benefits are protected.