Monday, July 17, 2017

Cigna Reinstates LTD Claim After Ramos Law Files Administrative Appeal

Ms. S sought legal representation from a long term disability attorney after Cigna denied the continuation of her long term disability benefits. Ms. S worked at a desk job that required repetitive typing motions.

Fortunately, Ramos Law was able to help her win back her LTD benefits.

Prior to becoming disabled, Ms. S had worked at a large investment services firm until the pain in her hands made it impossible for her to continue with her job.

Ms. S had bilateral carpal tunnel syndrome, trigger finger in multiple fingers as well as other severe issues in her wrists and hands. Ms. S underwent several surgeries and physical therapy sessions for these debilitating conditions. Unfortunately, her hand pain persisted despite aggressive treatment. Ms. S also had several other health issues which caused pain in her back, hips, foot, and ankle. Ms. S complained of pain in her hands, hips, and back both while working and during her long drive to and from the office each day. Ms. S’s doctor also recommended elevating her foot and ankle intermittently throughout the day, which also significantly interfered with her ability to work at the office.

Like many other LTD plans, Cigna’s policy in Ms. S’s case provides disability benefits for a period of 24 months if she is unable to perform the material duties of her regular occupation or “own” occupation. In Ms. S’s case, Cigna denied the continuation of her long term disability benefits, claiming that she was physically able to her own job.

Attorney Ramos thoroughly reviewed Cigna’s denial letter and Ms. S’s entire claim file. He noted that Cigna’s medical and vocational reports contained numerous inconsistencies and did not take into account the progressive nature of Ms. S’s conditions. As part of the administrative appeal that was submitted to Cigna, Ramos Law obtained new medical opinions from Ms. S’s doctors as well as a thorough opinion from a vocational expert.

Hiring our own vocational expert in this particular case was extremely helpful. Through the use of a vocational expert, we were able to prove that Ms. S’s could not perform the material duties of her own job without requiring the use of her hands and fingers at least two thirds of the workday.

Through the use of a more recent medical opinion and a vocational evaluation, Ramos Law was able to prove that Ms. S’s conditions continued to meet the definition of disability under the terms of the policy provided by Cigna. Besides the inability to use her hands on a frequent basis, our appeal also provided substantial evidence which showed that, non-exertional limitations such as chronic back pain did not allow her to maintain the pace and concentration needed to stay on task in an office that deals with challenging financial information.

Once Cigna reviewed the documents that Ramos Law filed in support of Ms. S’s case, Cigna was forced to reinstate her long term disability benefits. Our paralegal Jessica Smith was informed by telephone that Cigna had agreed to grant our appeal and told that a retroactive check had been issued to Ms. S’s for the amount owed in back due benefits.