- DISABILITY CLAIM FAQ
A federal district court judge issued a 44 page decision today that condemned CIGNA’s termination of a long term disability (“LTD”) benefit claim, which was consistent with the same type of bad faith claim decisions of CIGNA that were exposed on ABC News’ “Good Morning America.” That ABC News expose can be seen on the internet at http://abcnews.go.com/GMA/story?id=5257491&page=1. CIGNA arrogantly contended that as long as it went through the motions of supposedly considering the evidence that Plaintiff submitted its decision had to be upheld. The Court strongly disagreed for a variety of reasons.
First, the plaintiff’s medical records showed that his condition had not improved between the time that CIGNA approved and then subsequently terminated his LTD benefits. The Court criticized CIGNA’s termination “preceded by no significant change in the claimant’s physical condition”.
Second, the Court rejected CIGNA’s assertion that it could “reject the opinions of treating physicians for any or no reason at all.” To the contrary, the Court ruled that because CIGNA failed to “cite any rational justification for its decision to discredit Alfano’s treating physician evidence, this evidence is entitled to substantial weight.”
Third, the Court ruled that CIGNA “erred in discrediting the SSA decision,” especially since “it accepted the SSA decision awarding Alfano disability benefits without question when it reduced Alfano’s initial LTD benefits award by the amount of his SSD benefits.” To make matters even worse, the Court pointed out that CIGNA forces claimants to apply for SSD benefits; otherwise, CIGNA will reduce their LTD benefits by the estimated SSD benefits. The Court further chastised CIGNA’s disregarding the SSA decision because its definition of disability was basically the same as CIGNA’s; that is, the SSA specifically found that the plaintiff was unable to do his past work or any other work as well. Therefore, the Court found the SSA decision probative of the plaintiff’s claim for LTD benefits, and gave it substantial weight.
Fourth, CIGNA has a habit of intentionally misreading its functional capacity evaluation (“FCE”) reports. Rather than relying on the actual test data, CIGNA blindly accepts the conclusion of the physical therapist who performs the FCE, even when contradicted by the test data, over the opinions of treating physicians. The Court explained that “CIGNA offers no rational reason” for doing so. Therefore, the Court rejected the FCE, and all of the medical and vocational reports by CIGNA’s doctors and vocational consultants who relied on itPrevious Next
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