After Cigna and other disability insurance companies deny your claim, you should contact a disability lawyer to submit an appeal that covers all issues with your claim.
Attorneys Gregory Dell and Cesar Gavidia have noticed a common theme in the long-term disability insurance denials from insurance companies, including Cigna, otherwise known as LINA Life Insurance Company of North America. In reviewing claims of those who use the attorneys to file an appeal, the attorneys found that not only do the patients not have the proper physical examinations, but the insurance company relies on a short version of a job description.
After a Claim Denial
In some cases, people try to file their own appeals. However, in order to be successful in winning an appeal, you need to know how the insurance company – in this case, Cigna – looks at your original claim. Our attorneys have seen many, many denial letters and cases, and we have put together a specific way to reply to a denial. Although each case is different, they all have many of the same reasons for the denial. In most cases, your claim representative will tell you that the company does not have enough information to support your claim, but they do not tell you what you need.
Furthermore, they’ll tell you that you do not need an attorney. Without the attorney, chances are high that you will lose the appeal, too. You might think that you have a second “voluntary appeal,” but that is not always feasible. You could be giving the insurance company more reasons to deny your claim if you do not handle one or both appeals properly.
The Importance of Submitting Pertinent Information
If you do not submit enough evidence to win your appeal, then you want to go to litigation, you are stuck with what you’ve submitted. The court cannot look at additional evidence — it can only look at the evidence you submitted for your initial claim and for the administrative appeal. That is why it’s important to know what the insurance company’s doctors look at, so you can submit the appropriate information, which often means that you might have to get an independent medical exam or other tests.
When you hire an attorney to help you with your appeal, the attorney requests your administrative files from the insurance company. The attorneys then review the files, including all the notes, reports and memos generated by the insurance company’s in-house medical consultants. Yes, these doctors contributing to the decision to give you long-term disability work for the insurance company. They are there to look out for the insurance company’s bottom line — not your best interests.
The doctors review your file, but not you. Because our office has seen so many of these “medical reviews,” we know what extra testing that you need to get to dispute the insurance company’s doctors’ findings. For example, you might need to go for functional capacity testing, a neuropsychological exam or an independent medical exam (IME). The additional tests and exams help us dispute the insurance company’s findings.
Once we receive the results of the new testing, we are able to draft a custom statement that pertains to your specific case. In some cases, we may need to pull in additional medical support in the form of expert witnesses — doctors who testify about your disability on your behalf. While expert witnesses are usually used during litigation, we can use a written report from an expert witness to help with your appeal. We then present the additional information we gathered to the insurance company in a manner that no reasonable doctor is able to disagree with the presentation of the evidence.
Part of the problem with the denials is that the reviewers use a general job description for your job. Just because you are a receptionist with general duties of answering the phone, does not mean that you sit behind a computer all day. Your job might require you to lift items, such as reams of paper and other office supplies. Your job could also require you to act as a courier, and if your disability prevents you from driving, you would not be able to do your job.
Our attorneys will verify your job description by asking you what your employer expects from you. We may also request that a vocational consultant do an assessment of your occupation. The vocational consultant can also create a report of any occupations you might be able to do, based on your disability, your education, training and experience. In some cases, we might do our own market study of what jobs require and the intensity of the jobs that might be available.
When the insurance company’s in-house vocational consultant looks at your case, he or she looks at the limitations and restrictions from your doctor and then does a labor market analysis and/or a job report study to find the jobs you could do. However, because employers do not list all duties in every job, you might not be able to do many of the jobs the insurance company’s vocational consultant comes up with. In other words, the insurance company’s in-house doctors and consultants rarely look at the complete picture and often cherry-picks the information they can use to deny your claim.
Contact Attorneys Dell & Schaefer
If you are ready to file an initial long-term disability claim or you have been denied and are ready to file an appeal, contact one of our long-term disability attorneys to help you with your claim. Our initial consultations are free, and we take cases on a contingency basis — that means that you do not pay unless we win your claim. That also means that you have access to additional tests and experts to fight the denial of your claim — tests and experts that you might not be able to afford if you were to fight the claim denial on your own.