Long Term Disability Law BlogAttorneys Helping Disabled Claimants Nationwide

How to Prevent Your Cigna Disability Claim from Being Denied

If you’re like many disability claimants, you may be wondering how to prevent Cigna (or New York Life) from denying your claim for long term disability benefits. At Dell & Schaefer, we’ve handled hundreds of these claims and can explain why you need a certain amount of medical treatment and how you can expect the definition of “disability” to change under your policy. Learn more about how we can help you strengthen your Cigna disability insurance claim.

The Amount of Medical Treatment and Care from an Appropriate Medical Doctor is Essential

Even after you’re approved for long term disability benefits, you haven’t crossed the finish line – to continue to receive these benefits, you’ll need to maintain sufficient, ongoing medical treatment to chart your progress. If you stop seeing your doctor, Cigna may determine you’re no longer disabled and, therefore, no longer entitled to long term disability benefits. While there may not be a minimum number of doctors or medical professionals a long term disability claimant needs to see to continue to qualify for disability benefits, claimants should make sure they’re regularly consulting with a specialist in the area of their disability – a podiatrist for foot problems, an orthopedist for knee or back problems, or an endocrinologist for diabetes.

There are Traps in the Cigna / NY Life Claim Forms That You Can Avoid

Cigna has designed its disability claim forms to steer claimants (and their physicians) toward certain responses that can hurt them later. One of the claim forms is the claimant questionnaire, which will ask about restrictions and limitations on activity. Once the claimant has committed their abilities to paper, this can provide Cigna with objective evidence to look for when engaging in video surveillance (discussed in further detail below). Meanwhile, Cigna’s attending physician statements often provide the doctor with a list of options of work the patient can perform, quietly omitting “none” as a listed option. Given the choice between committing the patient to heavy-duty, light-duty, and sedentary jobs, the doctor may opt for “sedentary” as the least physically demanding option, even if the claimant is unable to perform this type of work. Claimants need to work with their physicians to ensure they’re aware they aren’t limited to the pre-printed answers the physician’s statement provides.

Does a Claimant Need to be Fearful of Video Surveillance?

One of the easiest and most cost-effective ways for Cigna to deny benefits may seem a bit like overkill – covert video surveillance of the claimant. This video surveillance can often be used to show that the claimant is exaggerating their disability based on their previous answers to the claimant questionnaire. Claimants should review their answers to the questionnaire carefully and avoid engaging in any of these activities, as Cigna has a knack for catching claimants on a “good day” performing activities that often are out of their reach.

When is the Best Time to Start Preparing for the Change of Definition for “Disability”?

Under a Cigna / New York Life long term disability insurance policy, the definition of “disability” is designed to change over time. Initially, a claim may be approved if the claimant can show that they can no longer perform their current job (known as the “own occupation” standard). But after a couple of years, depending on the policy, this standard may shift to an “any occupation” standard that will continue benefits only if the claimant can no longer perform¬†any¬†occupation. Claimants should be cognizant of this shift and be able to support their disability claim under the stricter “any occupation” standard. Dell & Schaefer can help. We’ve handled thousands of Cigna / New York Life claims and are highly familiar with their internal processes and just what they want to see in a claim packet. Give us a call today to set up your FREE consultation with one of our experienced disability attorneys.
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