Cigna recently approved a long-term disability (“LTD”) appeal for our client who lives in Boca Raton, Florida and who suffers from myasthenia gravis and related conditions. Prior to leaving work due to her disabling condition, our client worked as a hospice nurse.
Our client’s LTD benefits were initially approved, but after about one year Cigna ceased paying benefits. We worked with our client to gather evidence supporting her disability and refuting Cigna’s reasons for denying benefits. Her appeal was approved, and benefits reinstated.
Myasthenia Gravis
Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles. It causes serious muscle weakness and can cause double vision, difficulties with speech and chewing, shortness of breath, and impaired voice.
Our client also developed a thymoma – a tumor located in the thymus that is frequently associated with myasthenia gravis. She underwent surgery to remove the tumor and when she did, large portions of her chest and diaphragm were affected. A portion of her left upper lung lobe was removed, and her phrenic nerve was severed. Due to the surgical complications, our client suffered tremendously.
Because of her condition and the surgery, our client experiences severe pain, muscle weakness, fatigue, shortness of breath, and medication side effects such as confusion and memory impairment.
Cigna’s Termination
In its letter terminating benefits, Cigna stated that our client’s only documented deficit was “hoarseness.” This was a gross misrepresentation of her condition and symptoms. Often, insurance companies will selectively read medical records to support a decision to terminate benefits. This seems to have occurred in this case.
Our Appeal
We worked closely with our client and her physicians to gather the evidence we needed to convince Cigna to reverse its termination. Each of our client’s numerous physicians wrote detailed letters explaining her complex medical status and opining on her inability to work. Without the support of her treating physicians, it is unlikely we could have reached such a positive outcome for our client.
If you are facing a denial or termination from your insurance company, contact our firm. We work diligently to help our clients get the benefits they deserve.
