Here at Dell & Schaefer, we’ve handled hundreds of long term disability claims with Cigna and New York Life. We’ve learned a few things during this process – most of all, that proving you’re disabled to Cigna’s satisfaction can be a much tougher job than it first appears. Learn more about what Cigna looks for in a claim for disability benefits and how claimants can improve their odds of success.
Claimants Must Be Able to Show Ongoing Medical Treatment
It’s important to maintain ongoing medical treatment even if your doctors don’t have any specific additional treatments they can recommend for you at the time. To continue to pay long term disability benefits, Cigna needs to be able to see your medical records, including documentation that shows how your disability is currently affecting you. If your most recent medical records are six months old and you haven’t seen a doctor since, Cigna can conclude that while you may have been disabled, you no longer are.
Another problem arises when a claimant wants to avoid using pain medication due to the risk of addiction or negative side effects. Cigna may see this as a refusal to accept treatment and a tacit admission that the claimant’s pain isn’t that bad. But claimants should know that they’re not obligated to pursue any specific course of treatment – for example, a disability insurance policy won’t force a claimant to undergo surgery in order to continue to receive benefits. Claimants facing this dilemma may want to investigate alternative treatments or therapies that don’t require the use of opioid-based pain relievers.
Claimants should also ensure that they’re seeking treatment from at least one medical doctor. For example, if you’re seeking disability benefits for back problems, Cigna will want to see that you’re seeing an orthopedist, not just a chiropractor or massage therapist.
Avoiding Traps in Cigna’s Disability Claim Forms
Cigna spends a lot of time designing its long term disability claim forms, and for good reason – these forms can steer the respondents toward a certain response, which Cigna can then use as a basis to deny the disability claim. Doctors should know they’re not limited to the answers pre-printed on the form, which are written to assume that all claimants are able to perform at least sedentary work; doctors are free to add their own statement or indicate that the claimant is unable to perform any type of work.
This goes for claimants too. When filling out the claimant questionnaire and indicating which activities you can or can’t do, don’t think of what you can try on your best day, but what you know you can do on your worst day. Many claimants tend to underestimate the degree to which their conditions impact their daily lives.
Claimants don’t need to be afraid of video surveillance, but should be aware of it – though this surveillance may only last a day or two over the course of several years, it’s a rare claimant who completely escapes Cigna’s eye. It’s important for disability claimants to remember the specific activities they informed Cigna they couldn’t do and avoid these activities in public. Many disabling conditions tend to wax and wane depending on the day, so a claimant having a good day could be “caught” walking the dog or cleaning their gutters even if this type of activity is normally well out of their reach.
This is just another reason why it’s so important for long term disability claimants to have access to legal advice throughout the claims process. Cigna has built a number of potential pitfalls into its claims handling process, and an inexperienced claimant is no match for its team of disability representatives and attorneys. Let the team at Dell & Schaefer help you navigate your Cigna claim – give us a call today to set up your FREE consultation.