How to Appeal a CIGNA Denial of Long-Term Disability Benefits

Posted on June 17, 2019 by cjblog

Like many large insurance companies, CIGNA has been known to employ bad faith practices to avoid paying long-term disability benefits. Misplacement of medical records or repeated requests for authorization forms are just two of the many tactics the insurer uses to deny claims. If you're aware of the tactics CIGNA uses to deny your long-term disability benefits, that knowledge can help you prepare your claim and understand how to appeal a CIGNA denial.

CIGNA's Denial Tactics

1. Failure to Provide Updated Medical Information

When you apply for benefits, CIGNA will require you to sign forms to authorize your physician(s) to provide them with your medical records. If they do not receive authorization from your health professionals, they may deny your claim based on lack of medical information. Be sure to follow up with your physician to make sure they have submitted an authorization form to CIGNA.

2. Asking Physicians to Speculate on Treatment Outcomes

CIGNA may make repeated requests asking your physician to complete statements about your ability to work or asking them to provide statements about the possibility of medical improvement. If the company feels you can perform some of your work functions, based on your physician's statement, it is likely they will deny your claim.

3. Requiring Extensive "Any Occupation" Standards of Disability

It is common for insurance companies to review your disability claim after a specific period of time, such as 12 or 24 months. During this review period, CIGNA is able to conduct a new disability evaluation and may do any or all of the following tactics in order to deny you further benefits.

  • Require that you be evaluated by a physician of their choosing
  • Hire a private detective to follow you and confirm that your disability is legitimate. Private detectives sometimes use video surveillance during their investigations.
  • Require you to meet with a vocational consultant and/or have an RFC (residual functioning capacity) evaluation.

4. Using Deadlines to Deny or Terminate Your Claim

If you miss deadlines for submitting documentation, CIGNA may automatically deny or terminate your disability benefits.

How to Win Your CIGNA Disability Appeal

If you receive a claim denial, the following steps can help you successfully appeal the decision.

1. Be Aware All Deadlines

Appeals can take months and there is a limited time in which to file an appeal, typically 180 days. Begin working on your appeal as soon as you receive a denial to ensure you do not miss the deadlines outlined for the appeals process.

2. Request Your Claim File From CIGNA

CIGNA must provide you with information about the appeals process. It's important for you to understand how CIGNA conducted their review of your case and why they denied or terminated your benefits. When you receive your file from CIGNA, look carefully at the strategies they used to deny your benefits such as

  • Video surveillance
  • Medical results from their physician(s)
  • Non-compliance with your treatment plan
  • Social media search
  • Misinterpreting medical documentation
  • Missed deadlines

3. Be Familiar With Your Disability Policy Terms

You should read and understand your specific disability policy. Find out how the policy defines partial and total disability, what benefit limits are included, and what types of disabilities are excluded from coverage.

4. Provide Thorough and Accurate Documentation

Review all documentation you receive or request from your physician, a hospital or other treatment provider to ensure it is complete and accurate. Be sure to include the results of all tests, physician's statements, reports from your employer, and RFC report, a description of your job and how your disability prevents you from performing your work.

A word of caution. Many insurance companies employ the services of a private detective or another investigator to put you under video surveillance to dig up any evidence that your disability claim is not legitimate. Always assume you're under surveillance.

CIGNA may also search through social media looking for activities or situations that would disprove your disability benefits claim. Do not post information about your disability claim. Do not discuss the status of your disability case. Refrain from making negative statements about your disability policy or insurance company.

Remember: if your claim is denied, you have the right to appeal. You also have the right to file an ERISA appeal. Call us to find out more about the appeals process.

Learn More About How to Appeal a CIGNA Denial

At CJ Henry Law Firm PLLC, we have seen all the tricks of the insurance trade and can make sure you protect your rights. To learn more about how to appeal a CIGNA denial, contact us today.

This entry was posted in Blog by cjblog.