The Fight For Rights Wins!
Tim Davis – not his real name, but a real client – was involved in a major auto accident that left him a T-8 paraplegic no longer able to use his legs and impacting his nervous system controlling the lower half of his body, making him dependent on a wheelchair for mobility.
For years before and after his accident, Tim worked as a Mechanical Design Engineer for a leading company in health technology, requiring high cognitive abilities and extensive computer work – for the most part, a sedentary job.
However, the longstanding use of Tim’s arms to propel his wheelchair, along with repetitive use of his arms to do his job, led to permanent nerve injuries of his bilateral upper extremities. With a lucrative career that he loved, Tim pushed himself to continue working as long as he could, until chronic pain affecting his cognitive abilities and physical symptoms of bilateral carpal tunnel syndrome affecting his wrists; bilateral cubital tunnel syndrome affecting his elbows; peripheral neuropathy causing weakness, numbness and pain; decubitus ulcers caused by pressure sores from sitting too long; and pain from lumbar degenerative disc disease made it impossible for him to continue.
When Tim finally listened to his physicians’ recommendations, he reluctantly filed a claim for long-term disability benefits with his employer-sponsored disability insurance carrier, Cigna.
Cigna initially approved his benefits, but since Tim was a high wage earner, Cigna – as most disability insurance companies do – looked for a reason to stop paying him. Cigna interpreted Tim’s condition in his updated medical records as showing improvement when in fact Tim’s symptoms had worsened. Cigna also didn’t consider the factor chronic pain played on Tim’s ability to do his cognitively demanding job.
Cigna arranged for Tim to undergo a Functional Capacity Evaluation, the findings of which they found were consistent with the required physical demands of Tim’s job. However, the vocational evaluator determined that Tim could do LESS than sedentary work and likely wouldn’t be able to do full time work.
When Tim received notice of Cigna’s disability termination, he contacted me to appeal the decision. Drawing attention to Cigna’s misinterpretation of their own vocational evaluator’s report, and with well-documented and supportive medical reports from several physicians addressing Tim’s medical and cognitively limiting conditions, on appeal, Cigna reversed their decision, paying Tim the benefits he deserved.
Thanks to our experienced ERISA disability legal team, Tim’s long-term disability benefits were restored.
If your patients or clients find themselves denied benefits from their employer-sponsored disability program, contact me for a free review of their case. Why? Because I have your back when it comes to fighting for your rights. Case Closed.
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