As experts in long-term disability insurance claims, attorneys Greg Dell and Stephen Jessup explain the intricate layers involved in disability benefit denials and related lawsuits. Assuming that an individual by Cigna has completed all possible appeals and is now faced with filing a lawsuit, here’s a look the roadmap for filing that suit. From filing timelines to realistic expectations and possible remedies, these Dell & Schaefer disability insurance attorneys dig from a deep well of experience handling hundreds of Cigna claims, appeals and lawsuits across the country.
From Denial Letter to Lawsuit Filing
So, you’re holding a denial letter in your hand and have no idea what your options are – or even if any hopes of reprisal exist. The letter states that you have exhausted all remedies and the matter is closed. But that’s far from reality because that’s the point at which ERISA allows you to file a lawsuit to reassert your rights and claim legitimate disabled status.
According to disability insurance lawyer Stephen Jessup, the first and foremost step is to obtain the final claim file. That file holds all the medical reviews, the associated information you provided, and all the details of the appeal process. By law, Cigna has a duty to release that file after you file a lawsuit – but that release could come much later down the road. So, it’s extremely useful and more convenient to get the file prior to filing a lawsuit.
With that file in hand, your attorney will be better equipped to assess the chances of success. After analyzing the information and breaking it down for a rational approach, it’s then possible to establish realistic expectations for time frames and possible outcomes.
It’s now time to file the lawsuit, which is where knowledge and expertise are crucial. Greg Dell explains that a disability lawsuit governed by ERISA must be filed in federal court, and it can be any federal court in the country that holds the best chance of success for the client.
“A lot of inexperienced lawyers try to put it in state court,” says Dell. “But that should be your first clue that you’re talking to a lawyer who doesn’t know what he’s doing… You can’t go into state court, period. End of story.”
What is the Timeframe After Filing?
Attorney Stephen Jessup, whose practice is comprised solely of representing long term disability insurance claimants through the entire process of a disability insurance claim denial, including ERISA appeals and resulting litigation, reveals what happens once the lawsuit is filed in federal court. The judge must issue a scheduling order, then it potentially goes to summary judgment and on to a final verdict from the judge.
Depending on the federal court and the assigned judge, the timeframe could be anywhere from six months to two years – but realistically, the entire trial process could take up to 18 months. This starts with Cigna being served with the lawsuit papers, at which point they have 21 days to respond. Considering potential extensions, the initial resulting answer back from Cigna should arrive within a month. This is typically a formal document from them that basically denies everything in the complaint.
That’s when the wheels are set in motion for the scheduling order from the judge, which generally happens within 45 to 60 days. This sets the time periods for mediation, the filing of motions, whether the judge will allow a hearing on the motions, and an actual trial period.
What’s The Difference: Negotiated Settlement Versus Trial?
The reality, according to disability attorney Greg Dell, is that only about 98 percent of these cases go through a trial and get an opinion from a judge. Why? The reasons can be complex, but a major driving force behind a client’s decision to settle is financial considerations. It’s already been a long road from initial claim filing to a Cigna denial, the ERISA appeal, and then the final denied disability claim. It could have already been nine months to a year since the client has been paid.
“There’s no money coming in. It’s a huge financial problem,” says Dell. “Our job when we get retained is, how quickly can we get the benefits reinstated or how quickly can we get to some kind of negotiated settlement to get this matter resolved?”
There’s also the possibility that the insurance company will prevail in a lawsuit and that the disabled client will end up with nothing. This reality is more serious than most people realize, primarily because the existing material in the client’s original claim file and appeal is the only evidence that the judge will ever see.
“You don’t testify. Doctors don’t testify. You’re not going to have a jury,” explains attorney Stephen Jessup. “The federal judge is going to review the information that’s in that claim file only. So, if you had new information that came about after that final denial, that’s not allowed for a judge to consider.”
As unfair as it sounds, that judge is going to determine only two things. One, does he or she think you’re disabled? And two, did Cigna have a reasonable basis to deny the claim? Based on what’s in that claim file, the odds are stacked in favor of the insurance company.
As dire as that may sound, Cigna does have something to gain from settling. They already know what happens when they go toe-to-toe with a Dell & Schaefer disability insurance attorney and that it won’t be an easy win, based on the firm’s vast experience fighting denied disability claims. Cigna also realizes that they’ll end up paying their own lawyers thousands of dollars to defend a lawsuit if they choose to go that route. By law, they are required to place a certain amount of monetary assets in reserve during an ERISA lawsuit, which ties up funds that can be released and reinvested after a successfully negotiated settlement.
What If You Win the Lawsuit?
Finally, the potential of winning a much larger amount of money in a trial verdict warrants consideration. But here’s the reality and the risks in an ERISA lawsuit, which disability insurance attorneys Dell & Schaefer help you evaluate. What most people don’t realize is that if you win that lawsuit, what you’re actually winning is your back benefits. You don’t automatically win the next 10 years that you’re owed in benefits, according to Greg Dell. Cigna can re-evaluate you any time after the lawsuit and send you to a doctor who determines that you’re better now and that you can return to work. Cigna could also appeal the judge’s ruling in your favor, which means you have to start the entire dispute all over again. By contrast, a negotiated settlement is a done deal and money in your pocket.
How to Move Forward Now
Now that you’re fully informed on how the process works and on the risks and potential rewards of an ERISA lawsuit, it’s time to move forward and get the entire ordeal moving toward final resolution. Just click the free consultation button on the Dell & Schaefer website or call for a direct conversation. The firm never charges fees or costs to represent you if a review determines that they can help you get a recovery in your claim. As claim partners, everyone wins from a successful resolution – and you can move on with your life in a positive way.