In a December 2, 2011 lawsuit filed in the United States District Court for the Middle District of Pennsylvania, Sharon H. and her Pennsylvania disability attorney allege that CIGNA Group Insurance unjustly terminated Sharon H.’s disability benefits.
Claimant Sharon H., a 53-year-old respiratory specialist, was covered by CIGNA for long term disability benefits as a provision of her employment disability insurance policy, which must adhere to provisions of the Employee Retirement Insurance Act of 1974 (ERISA). Having been declared disabled by the Social Security Administration (SSA) since October 14, 2008, Sharon H. attempted a trial work return at American Homecare Supply until March 2009. At that time, Sharon H. discovered that she was unable to return to her job and made an application for and received her short term disability benefits from CIGNA.
CIGNA Claim Denial
Then, CIGNA continued to pay Sharon H. her long term disability benefits for two years. However, on June 24, 2011, CIGNA told Sharon H. that it believed she “could return to the work force, contrary to the opinions of her treating physicians.” After filing the mandatory administrative appeal to challenge this decision by CIGNA, CIGNA again denied her claim. Sharon H. found herself disabled with no benefits from CIGNA. Sharon was forced to file this lawsuit. Sharon H.’s disabling condition is described as “complicated” and is diagnosed as an osteoarthritic condition of her hands and legs which requires multiple surgeries. Claiming that she continues to suffer from her disabling conditions and that she is unable to perform the duties of her occupation, Sharon H. and her attorney allege that she is entitled to her long term disability benefits from CIGNA. Her submitted medical records “clearly establishes her continued right to disability benefits” and solidifies her claim.
Claimant Requests Restitution from Pennsylvania District Court
Claiming that Sharon H.’s medical evidence is insufficient for proof of a disability, CIGNA has stubbornly continued to stand by its termination of her claim. Consequently, Sharon H.’s disability attorney states in her claim that the insurer determined Sharon H.’s fate in bad faith. With no evidence of improvement of her condition, Sharon H. and her Pennsylvania disability lawyer accuse the insurer of not evaluating Sharon H. appropriately and specifically request that the Pennsylvania District Court award Sharon H. the following.
- Declare her disabled;
- Award her the continuation of her long term disability benefit payments;
- Award her all past due and overdue long term disability benefits;
- Award her interest on all past due and overdue benefits;
- Award her reasonable costs and attorneys’ fees under 29 U.S.C.A. § 1132(g); and
- Any other relief the court deems necessary and appropriate under the circumstances.