Cigna again finds itself in court over termination of entitled disability benefits. In the United States District Court of the Eastern District of Pennsylvania case Gena N. v. Liberty Insurance Company of North America a/k/a Cigna, Gina N. and her Pennsylvania disability attorney have appealed to the District Court to enter a judgment against the insurer for an award of her full and complete payment of long term disability benefits from the date of the termination of her long term disability benefits moving forward per the terms of her employee CIGNA plan, reasonable attorneys’ fees, costs and "expenses as permitted under ERISA, interest and any other equitable relief" the Court deems appropriate.

Office Manager Hires Disability Attorney to File Lawsuit against Cigna

Gina N. was employed at Drexel University College of Medicine as the Office Manager until February 7, 2003 when she ceased work as the result of a serious lower back injury which she sustained when she slipped and fell on ice in a parking lot. After intensive medical treatments and failed surgeries, Gina N. was forced to stop working, applied for her Cigna disability benefits, was awarded those benefits, and was awarded Social Security Disability Benefits. Then in January of 2009, some seven years later, Cigna terminated Gina N.’s disability benefits, basing its decision on its allegation that Gina N. "was not in compliance with the policy for failure to attend a scheduled Functional Capacity Evaluation (FCE), and by February 2010, Gina N. had exhausted all her administrative appeals forcing her to seek the assistance of a disability attorney to litigate her case.

Attorney Says Cigna was Arbitrary and Capricious in Denial of Disability Benefits

Charging Cigna with arbitrarily and capriciously terminating and denying her long term disability benefits, Gina N. and her disability attorney state that Gina N. had at all times sent medical documentation to the insurer as required, verifying her disabled condition. In addition, while Gina N. did miss one FCE appointment, she did undergo an FCE on November 17, 2009 and the test revealed that Gina N. did have limited movement and did suffer from back pain; the report did not, however, evaluate whether Gina N. had the "exertional capacity to re-engage in even a sedentary level position." In fact, Gina N. provided Cigna with this FCA report in one of her appeals to no avail. Gina N. and her attorney believe, and state in her complaint, that the insurer upheld its termination of Gina N.’s disability benefits on the exclusive opinion of a doctor from MLS Group of Companies, a peer review and report ordered by Cigna.

Doctor for Cigna Passed Judgment without Examining Claimant in Person

The doctor who evaluated Gina N.’s claim did not personally interview or evaluate Gina N.’s medical condition and, in fact, used a "standard form instruction sheet that it transmits to the physicians it selects and contracts with to conduct evaluations, which form is not contained in Cigna’s claim file," but which instructs evaluating physicians to "ignore subjective complaints" and limits the scope of any investigation. Gina N.’s attorney thus alleges that Gina N.’s assessment was "intentionally constrained" and that the assessment ignored her medical records and that the evaluation of "her condition was unfair, inappropriate, misleading, and did not constitute anything remotely resembling an ‘independent medical evaluation’."

In addition, Gina N. and her attorney allege that Cigna breached its disability insurance contract with Gina N. in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) by not providing a full and fair review of Gina N.’s claim. They allege that these violations entitle Gina N. to a judgment of wrongful denial on Gina N.’s claim, and seek to reinstate her long term benefits and compensation for attorneys’ fees and other damages to be determined by the District Court.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.