After suffering a traumatic brain injury (TBI), a pharmaceutical detailer in St. Louis, Missouri had deficits in attention, memory, and mood. He also suffered from sleep disorders, degenerative disc disease, radiculopathy, neuropathy, joint disease, shortness of breath, morbid obesity, chronic headaches, and back pain. As a result, he was forced to stop working and filed for long-term disability benefits (LTD) under his policy with CIGNA.
Fortunately, CIGNA approved and paid our client’s claim. Later, however, the insurance company terminated our client’s benefits, prompting him to contact Dabdoub Law Firm.
Periods of Disability
CIGNA paid LTD benefits throughout the entire “own occupation” period, in which a claimant must only be incapable of performing the duties of their own job. After this period, a claimant must be disabled from any occupation they are qualified for.
Although CIGNA acknowledged our client was disabled from his own occupation, the company claimed he was not disabled from any occupation. Nevertheless, our client’s transferrable skills analysis (performed by CIGNA itself), revealed that he is only qualified for the position of pharmaceutical detailer – his own occupation under the dictionary of occupational titles.
By claiming our client is capable of working, CIGNA is effectively saying that our client has somehow become “undisabled.” The evidence disagrees.
Testimony from Our Client’s Treating Physicians
Our client’s neurologist has been treating him for years due to multiple concussions and TBI. The doctor notes our client’s problems with attention, memory, mood, and sleep, as well as his impaired executive functioning, headaches, severe fatigue, falls, depression, and emotional liability.
CIGNA twisted this medical evidence, classifying our client’s primary diagnosis as a mental health disorder. Even though our client suffers from anxiety and depression, his primary diagnosis is TBI. His TBI is supported by objective medical evidence, as an MRI shows “multiple regions where the rate of brain shrinkage exceeded that of expected for his age group.” Our client’s rapid deterioration is the result of his many concussions and causes his neurocognitive symptoms.
Dabdoub Law Firm reminded CIGNA that mental health conditions are different from cognitive impairments and quoted doctors who believe our client is unable to return to work in any capacity. Sadly, our client’s brain atrophy is progressive and not expected to improve.
CIGNA has ample medical evidence, an independent neuropsychological evaluation revealing dysexecutive syndrome and slowed mental processing speed, and an independent functional capacity evaluation (FCE).
Our client cannot sit for more than 30 minutes at a time or 2 ½ hours in a workday, stand for more than 10 minutes at a time or 45 minutes in a workday, or work any job that fits his training and skillset.
As the FCE states, our client is “not be capable of sedentary work due to the subject’s whole body pain, poor endurance, shortness of breath, decreased tolerance to prolonged standing/walking, decreased balance, impulsive movements when fatigued, and extensive past medical history.”
When Dabdoub Law Firm spelled out our client’s disability and CIGNA’s responsibility under the Employee Retirement Income Security Act of 1974 (ERISA), the insurance company had no choice but to reinstate our client’s benefits.
Our Lawyers Specialize in Disability Insurance Claims
Because our law firm has always focused only on disability insurance, our lawyers are experts in legal representation for disability insurance benefits.
That means our disability lawyers have:
- Won several major disability lawsuits and improved the law for disability claimants.
- Experience fighting every major insurance company, including UNUM, Hartford, MetLife, CIGNA, Prudential, and others.
- Successfully represented hundreds of clients and won millions of dollars in disability benefits.
Federal law applies to most disability insurance claims, so we can help clients across the country.
Disability insurance companies have lawyers. You should too. Contact Dabdoub Law Firm to get experienced disability lawyers on your side.
We can help with:
- Submitting a disability insurance claim,
- Appealing a long-term disability denial,
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Call us at (800) 969-0488 for a free consultation with a disability attorney. No fees or costs until you get paid.
