As a senior actuary, our client was insured for long-term disability benefits through Life Insurance Company of North America (Cigna). Unfortunately, because of the debilitating effects of McArdle’s disease, and based on the recommendation of his treating physicians and neurologist, he applied for long term disability insurance benefits. Relying solely on a review of our client’s medical records by its own employees (an in-house nurse and medical director), Cigna denied his claim. The decision ignored the supporting medical opinions provided by his physicians – opinions that were provided on Cigna’s own standardized disability forms.
Grabhorn Law was retained to pursue an appeal. With the cooperation of his treaters, an appeal with supporting documentation of his restrictions and limitations was filed. However, Cigna failed to respond to the appeal.
Pursuant to the ERISA claim regulation, as well as the long-term disability insurance policy, Cigna was required to issue a decision on the appeal within 45 days. When Cigna did not comply with its ERISA obligations, Grabhorn Law prepared and filed a detailed legal complaint, initiating a lawsuit against Cigna.
Shortly after the ERISA lawsuit was filed, and despite not issuing a decision on our client’s appeal for over six months, Cigna agreed to approve our client’s claim for long-term disability insurance benefits. The decision resulted in a retroactive payment of disability insurance benefits, and ongoing monthly disability insurance benefits.