Four Plaintiffs Sue Cigna For Denial Of Long-Term Disability Benefits in California and Pennsylvania
Cigna Life Insurance Company Of New York (Cigna) faces four lawsuits in the Federal Courts of California and Pennsylvania for denying long-term disability benefits to the disabled claimants. In all four filed cases, Cigna is accused of wrongfully denying the long-term disability (LTD) benefits as defined by the respective Policies. Let’s take a closer look at each case:
Case 1: California
In George M. v. Cigna Life Insurance Company of New York, Plaintiff filed a long-term disability lawsuit via a California disability attorney. The Plaintiff was employed as a programmer analyst by Brown Brothers Harriman & Co. (BBH), which contracted with Cigna to provide long-term disability benefits to its employees. Due to his employment with BBH, Plaintiff was covered under the terms of the Policy.
On or about October 31, 2009, Plaintiff ceased working at BBH due to non-limited medical conditions and debilitating fatigue and filed a claim for long-term disability benefit payments. On or about August 2, 2010, Cigna denied Plaintiff’s claim, and upheld that decision on April 28, 2011. Cigna has still not paid any benefits to the Plaintiff beyond the end of the Benefit Waiting Period.
Plaintiff filed this lawsuit to have the Court declare that Plaintiff is disabled according to the terms of the Policy and should be entitled to all the benefits as defined by the Policy.
Case 2: Pennsylvania
In Kathryn M. v. Life Insurance Co. of North America d/b/a Cigna Group Insurance (Cigna), Plaintiff filed this lawsuit through a Pennsylvania disability attorney to gain the long-term disability (LTD) benefits that are defined in the Policy she is covered under due to her employment as a registered nurse by the University of Pittsburgh Medical Center (UPMC), which contracted with Cigna to provide LTD benefits to its employees.
After May 2007, Plaintiff could no longer work at her occupation due to the development of significant medical conditions that required extensive medical treatment. Plaintiff filed for LTD benefits as defined by the Policy. Cigna approved the claim and provided LTD benefits as of November 20, 2007 through November 19, 2009, at which time Cigna ended those benefits. Cigna’s reason for ending the benefits was that the Plaintiff could not satisfy the Policy’s definition of disability after the first 24 months.
Plaintiff has exhausted her administrative appeals, which has led to the filing of this lawsuit.
Case 3: Pennsylvania
In Richard M. v. Ebdman Anthony & Associates Inc., Long Term Disability Plan (Ebdman) and INA Life Insurance Company of New York (Cigna), Plaintiff filed this lawsuit through a Pennsylvania disability lawyer to gain disability benefits that were wrongfully denied to him according to the terms of the Policy. He was covered under this Policy due to his full-time employment at Erdman Anthony, Inc., which contracted with Cigna to provide long-term disability benefits.
After October 24, 2004, Plaintiff stopped working due to Stiff Person Syndrome, leading to him filing a claim for benefits under the Policy. Cigna approved the claim due to Plaintiff’s inability to perform his “own occupation” and began making payments as of November 24, 2004. In November 2006, the disability definition under the Policy changed, now requiring the Plaintiff to prove that he could not perform “any occupation” that was suitable based on Plaintiff’s age, education, training, and experience. Plaintiff continued receiving benefits through December 3, 2010, including the additional benefit of a Waiver of Premium for his life insurance policy.
Via letter on October 28, 2010, Cigna denied the Plaintiff from participating in the Waiver of Premium program. Again via letter on November 4, 2010, Plaintiff was denied future long-term disability payments. Plaintiff decides to appeal the decision in December 2010, leading to an extensive appeal being filed on May 2, 2011. This included a sworn statement by the Plaintiff’s treating neurologist.
However, a peer review was completed by board-certified neurologist that declared that Plaintiff could work full time if specific restrictions were applied, including being able to sit and reach at desk level. Due to the peer review report, Cigna again denied Plaintiff’s request via letter on July 15, 2011.
While Plaintiff could have requested another administrative appeal, Plaintiff felt that filing this lawsuit was the best course of action.
Case 4: California
In Katherine B. v. Cigna Group Insurance, the Plaintiff filed this lawsuit through a California disability lawyer to receive declaratory relief and to receive benefits under the ERISA plan. Plaintiff was employed as a human resources administrator at General Atomics from July 13, 2009 until October 23, 2009 when she was no longer able to work due to ear pain, headaches, dizziness, nausea, neck pain, sensitivity to sound, and sporadic double vision. Because of her employment at General Atomics, she was covered under a long-term disability Policy that was administered by Cigna.
On or about January 8, 2010, Plaintiff filed a claim for long-term disability benefits. Cigna was unable to determine her disability status and stated via a letter on or about January 27, 2010 that they would need to do further investigation into her status. A medical assistant from her primary care physician’s office, mentioned on or about April 13, 2010 that she was contacted by a Cigna nurse asking for help in reading Dr. Sturgeon’s handwriting. The Cigna nurse tried to gain additional information about the Plaintiff, including whether she was in an accident or not. The medical assistant told the nurse that all future correspondence would need to be done in writing.
Cigna requested that the Plaintiff submit to an independent medical examination (IME), which the Plaintiff agreed to, and had on or about September 8, 2010. During the IME, the physician, Dr. Lawrence Fogel, placed pressure on the Plaintiff’s head, causing a new pressure sensation inside of her head. The Plaintiff called Dr. Fogel’s office to complain about this pain on or about September 9, 2010, of which Dr. Fogel never mentioned in his report. He came to the conclusion that the Plaintiff’s health problems could be controlled via present medications and treatment and that she had no current medical complaints.
Plaintiff suffered a seizure-like episode on or about September 11, 2010 at a restaurant after experiencing severe head pain. Through a visit with a local doctor, the seizure was confirmed. This prevented the Plaintiff from seeking part-time work.
Cigna informed Plaintiff on or about October 7, 2010 that Plaintiff would no longer receive LTD benefits beyond September 21, 2010 because of Dr. Fogel’s IME report that claimed Plaintiff’s symptoms were controllable and that her sedentary level work capacity fell within her current job description.
The Social Security Administration declared via letter on or about March 13, 2011 that the Plaintiff had been disabled since October 23, 2009 and was entitled to benefits beginning in April 2010 for $1,274 each month.
Plaintiff has exhausted all administrative remedies, which has led to the filing of this lawsuit.
Plaintiffs Seek The Following Relief From Cigna
Through their respective lawsuits, the Plaintiffs seek the following relief from Cigna:
- An award of all benefits not paid to this point as should have been paid according to the terms of the respective Policies, along with accrued interest
- An award of all future benefits so long as the Plaintiffs remain eligible as defined by the terms of the respective Policies
- All reasonable attorney fees
- All related court costs
- All other relief that the Court declares to be just and proper