Ms. R. was an executive of a large corporation for over 12 years. She was on track to take over the eastern division of her company. Ms. R. began noticing that during the day, she felt fatigued; however, it was not a normal feeling of being tired. It felt more like a weight draped over her body and mind. She assumed that she was just run down and needed a vacation. On the weekends, she stayed in and rested. However, this did not help. She was struggling to stay awake at work and focus during telephone calls and meetings. Ms. R. also began suffering from severe joint pain and body aches. At first, she assumed that this was just a product of her exhaustion – her body and mind were overworked. Before Ms. R. took over the eastern division, she decided to go on a two week vacation. She hoped that the time off would rejuvenate her. Unfortunately, the pain and fatigue did not go away with rest. In fact, she never felt worse. Despite this, Ms. R. returned from her vacation and started in her new position. However, as time went on, Ms. R.’s severe pain and fatigue only increased. She was struggling to get through each day. She was taking naps in her office, leaving work early, and forgetting important meetings. Ms. R.’s co-workers began to notice a change in her work product. At this point, Ms. R. knew something was wrong and began the long and frustrating process of trying to find a medical reason for her concerning symptoms.
Ms. R. went to multiple specialists, underwent numerous tests, and took countless medications to no avail. Ultimately, Ms. R. found her way to a rheumatologist who was finally able to diagnose her with fibromyalgia – a condition with which Ms. R. was unfamiliar After doing some research, all of her symptoms made sense. Ms. R. tried multiple medications, deep tissue message, and physical therapy. Each provided minor and short lived relief. She also noticed significant side effects with her medications. Despite finally having a diagnosis and a treatment regimen, Ms. R.’s condition continued to deteriorate. She started missing more work and when she could come in, she was so exhausted by mid-day that she could barely function. Her cognitive impairments became more pronounced, her pain excruciating, and she simply could no longer handle the physical and mental demands of her job. Ms. R. took a leave of absence and applied for short-term disability under her Cigna disability insurance policy. She hoped the rest would allow her to return to work. Unfortunately, that was not the case.
Ms. R. was approved for short-term disability and began receiving weekly disability checks from Cigna. As that was ending, Ms. R. spoke with her specialists who recommended that she not return to work. At that stage, Ms. R. accepted that she was no longer able to perform the duties of her occupation. Thus, Ms. R. applied for long-term disability under her Cigna policy. She assumed that she would be approved, as the definition of disability under Cigna’s short-term policy was virtually identical to the definition of disability under Cigna’s long-term policy. Ms. R. was wrong.
Cigna began “investigating” Ms. R.’s eligibility for long-term disability only after her short-term benefits ran out, leaving Ms. R. without income. Ms. R. assumed an approval would come shortly. Again, she was wrong. Cigna required Ms. R.’s physicians to complete forms and called them for information regarding Ms. R. After a long “investigation,” Ms. R. was surprised to receive a denial letter from Cigna. She was even more bewildered to hear that the main reasons Cigna cited for denying her claim were that her treating specialists allegedly told Cigna were was not objective evidence of her disability and they could not assert that she was disabled. Ms. R. was confused because her physicians told her she should not return to work. At that point, she almost gave up. She was in too much pain and too exhausted to fight. However, she would soon run out of savings and she simply could not return to work. She called her rheumatologist and asked for clarification. Ms. R. was stunned to find out that Cigna completely misrepresented her physician’s statements. That is when Ms. R.’s rheumatologist urged her to contact Disability Insurance Law Group, a law Firm who represented two of her doctor’s other patients.
Ms. R. retained us to prepare her disability insurance appeal for Cigna. The first thing we did was obtain a complete copy of Cigna’s file, including their claim notes, medical records review reports, telephone conference notes, and internal communications regarding our client and her claim. It was clear that Cigna did not “investigate” our client’s claim in good faith. Cigna failed to obtain relevant information and hired two physicians, who Cigna regularly pays to evaluate Ms. R.’s records. What also became clear was that in claiming that there was not “objective evidence” of Ms. R.’s “disability,” Cigna and its hired reviewers simply ignored extensive evidence of her condition, which is known in the medical community to cause the symptoms and limitations described by Ms. R. and her specialists.
We contacted Ms. R.’s specialists and obtained sworn affidavits explaining that Cigna and its hired reviewers took their statements out of context and significantly misrepresented their opinions. They explained that while there are not tests that can objectively measure an individual’s pain or fatigue level, there was clinical evidence of her condition and they objectively observed Ms. R.’s limitations. We also sent Ms. R. to an independent medical expert, who administered a Functional Capacity Evaluation, providing objective evidence of Ms. R.’s functional limitations. We also obtained sworn statements from Ms. R.’s family members, friends, and two co-workers detailing her functional and cognitive impairments. Further, we obtained a detailed symptoms log from Ms. R. and a video statement addressing her restrictions. Finally, we investigated Cigna’s hired reviewers and found that they made a significant amount of money per year from Cigna for these reviews, they had little to no experience in treating patients with fibromyalgia, and one physician had been sanctioned by his state medical board for inappropriate conduct. With all of this information, we submitted a detailed appeal to Cigna and demanded the immediate approval of Ms. R.’s claim and all benefits owed to our client. Within the 45 day appeal review deadline, the Denial of benefits was overturned and a check for all retroactive payments due to Ms. R was sent from Cigna. She was placed back on claim and we continue to assist her in her ongoing claim for benefits.
Disability insurance law group represents claimants at all stages of the claims process. If you have any questions regarding your disability policy or claim, please do not hesitate to contact us at (866) 363-3628 or through our website www.DiLawGroup.com. Your disability insurance company has an entire legal team representing its rights. Isn’t it time you did as well?