Scam Alert – Disability Denial Again

Prematurely denying disability claims based only on a job title and intentionally disregarding all the specific job skill sets and duties required to perform a job, is a strategy used by many insurance companies to justify not paying benefits. Such was the case with our client, Mary Smith.

Mary Smith is a fictious name to protect our client’s identity. She came to our office seeking justice after being denied the benefits she so deserved.

Mary worked as a Veterans Contact Representative. Her job required an exceedingly high level of cognitive and verbal communication skill sets that included: an effective, persuasive, and clear speaking voice, excellent diction, and phonetics while she discussed ideas and communicated information to veterans.

When a stroke damaged both the right and left side of Mary’s brain, CIGNA accepted and paid her Long-Term Disability benefits. However, it didn’t take CIGNA long to change course, reversing that decision and cutting off her benefits.

In the months prior to termination of her claim, Mary was hospitalized to remove a blockage and insert a stent that kept blood pumping into her heart. A week later, she was readmitted to the hospital with confusion and difficulty speaking.

Despite these medical interventions and evidence of continued brain trauma affecting her cognitive and verbal capabilities, CIGNA terminated her benefits based on a paid CIGNA Occupational Evaluation doctor who only provided evidence of Mary’s physical condition such as a normal gait and normal neurological exam.

We fought back.

Obtaining Mary’s neurological and speech therapists reports, we successfully argued that due to Mary’s cognitive and linguistic deficits, she no longer had the capacity to perform in the occupations identified by CIGNA’s paid Vocational Counselor and that it was an abuse of discretion to focus only on Mary’s physical condition and disregard the other skill sets – cognitive and linguistic – required of Mary’s job/occupation.

Mary won her benefits. Case Closed.