Insurance companies are notorious for using the excuse “not an active, full-time employee” to deny disability claims. Such was the case with our client, Heidi – a fictitious name to protect her identity – when she came to me after receiving her denial letter from CIGNA.
I’ve seen this denial tactic before and knew it required us to go above and beyond in our appeal to secure the maximum benefits to this deserving client.
After years as a Medical Center administrative professional with excellent performance reviews in a job requiring a high degree of concentration and cognitive clarity, Heidi’s performance started to decline after she suffered from a stroke. Heidi’s employer wrote a performance improvement plan that Heidi eventually could not reach because of her stroke related disability and other medical conditions. Subsequently, Heidi lost her job.
After her termination, Heidi filed a claim for short-term disability (STD) benefits based on a recent diagnosis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL, which causes cognitive difficulty.
Her medical records showed that in the months before her performance improvement plan, Heidi suffered a stroke, affecting her left arm and leg though she continued working despite receiving physical therapy for her physical condition. Later, genetic testing confirmed a diagnosis of CADASIL and a neuropsychological evaluation found Heidi suffered from cognitive deficits.
We appealed after CIGNA ignored this medical disability evidence by prematurely denying Heidi her disability benefits.
Armed with a series of reports in our appeal that included – her neuropsychologist evaluation, pre- and post-stroke performance reviews, medical research, and her declining performance months prior to her termination – we were able to prove Heidi was working full-time while being disabled when she was terminated from her job. Heidi won both short-term AND long-term disability benefits. CASE CLOSED.
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