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Cigna/New York Life

Your Disability Benefits Have Been Denied Or Terminated By Cigna/New York Life. What Can You Do? The ERISA Law Center Can Help You.

Most disability benefit claims are governed by ERISA. Some disability benefit claims, those based on government plans and some church plans, are not governed by ERISA. Either way, the ERISA Law Center can help you. We regularly represent persons who have been denied both and ERISA and non-ERISA disability benefits by Cigna/New York LIfe.

Disability benefit claims denied by Cigna/New York Life often follow a common pattern. Sometimes Cigna/New York Life denies disability benefits because you or your doctors did not complete and submit to Cigna/New York Life forms or medical records it requested. You can often fix that problem yourself by completing the forms, seeing your doctor, and getting your doctor to complete forms, and provide medical records.

Sometimes Cigna/New York Life denies disability claims without paying any benefits or after paying only short-term disability benefits. A common Cigna/New York Life practice in such denials is that Cigna/New York Life only obtains a few months of your medical records and does not get records from all of your doctors. Then its in-house doctors and nurses “cherry-pick” those records, resulting in a denial of your benefits. You can sometimes correct that problem yourself by submitting all your medical records and having one or more of your doctors provide letters explaining why you cannot work.

In most Cigna/New York Life disability policies, the definition of “disabled” changes after you receive 24 months of benefits. For the first 24 months, you are entitled to benefits if you are unable to do your own occupation. After 24 months, you are entitled to benefits only if you cannot do any occupation. Cigna/New York Life will often terminate disability benefits with just a few months of “own occupation” benefits to be paid. Another common pattern is that Cigna/New York Life terminates benefits after paying all the “own occupation” definition of disability benefits.

Often Cigna/New York Life will deny or terminate disability benefits during the “own occupation” definition of disabled not because it claims you can do your own job but because Cigna/New York Life claims you can do a similar job. Most Cigna/New York Life policies define “your occupation” not as what you actually do for your employer but what people doing similar jobs generally.

Most Cigna/New York Life disability policies have a change of definition to the “any occupation” definition after you receive 24 months of benefits. Often Cigna/New York Life terminates benefits at the end of 24 months, claiming you can do some other job. Often the jobs Cigna/New York Life claims you can do are make-believe. Often the wages Cigna/New York Life claims you can earn are also make-believe. But, Cigna/New York Life has a report from a vocational expert – employed by Cigna/New York Life who says you can perform these jobs and earn these wages.

When Cigna/New York Life denies or terminates benefits it invites you to request a review and file and “appeal.” Typically, after the appeal is submitted Cigna/New York Life obtains new medical or vocational reports and invites you to review those new reports and comment on those. When you only have a few months left of benefits under the own occupation standard and it denies those benefits, it forces you to do a full appeal and to comment on its new medical and vocational reviews for just a few months’ benefits – and then typically denies benefits again when the definition of disabled changes to the any occupation definition.

Sometimes Cigna/New York Life pays disability benefits for the entire own occupation period and then for many years under any occupation definition of disabled. Sometimes you can go for years without Cigna/New York Life ever requesting new medical records – just an annual statement from you and your doctor that you continue to be disabled. But then Cigna/New York Life terminates your disability benefits even though you have never gotten better.

Cigna/New York Life uses a variety of medical professionals – nurses and doctors it employs and nurses and doctors employed by others to review your records. These nurses and doctors often “cherry-pick” your medical records – picking bits and pieces out of context to support the conclusion that you are capable of working.

Sometimes Cigna/New York Life will require that you attend an “independent medical examination” or a “functional capacity evaluation.” Often Cigna/New York Life secretly surveils you while you are going to and from these examinations and on the days before and after these examinations – and then claim that because you can walk to your car, drive your car, and maybe fill it with gasoline, you are capable of working.

Cigna/New York Life uses a great many in-house doctors and nurses to evaluate claims; their reports and opinions are almost always one-sided. Cigna/New York Life will often send claimants to independent medical examinations during the course of an appeal and sometimes before the appeal. Cigna/New York Life will often secretly surveil claimants on the days of their independent medical examinations and on the days before and after the independent medical examinations.

Cigna/New York Life commonly offers claimants a second “voluntary” appeal when benefits are denied. This means that the appeal process after a denial or termination of benefits is often dragged out: your benefits are denied; you submit an appeal; Cigna/New York Life sends you to an independent medical examination; Cigna/New York Life then sends you the reports from its independent medical examination and other medical reviews; you respond; your appeal denied – but Cigna/New York Life offers you a second voluntary appeal, and the process starts again.

Cigna/New York Life sometimes pays claimants for years, getting no records for many years, perhaps only an annual from you and your doctor, and then suddenly start an elaborate work-up. This means you have been targeted. There are two key points to remember about this process if this happens to you: once Cigna/New York Life usually doesn’t get records about you for years, it won’t get them now. So any doctor it sends you to won’t have all your records to evaluate. It is important that you make sure that all of your records for all of the years Cigna/New York Life didn’t ask for records are submitted to Cigna/New York Life and that the IME doctor has them. Otherwise, you are going to get a medical examination report that concludes that you have few restrictions and limitations and which Cigna/New York Life will rely on to terminate your benefits or deny your appeal.

The law – whether ERISA or if not an ERISA claim, state law – gives you the right to fight back to recover your disability benefits. The ERISA Law Center can help you. We know the law. We know Cigna/New York Life’s common practices. We know what evidence you need to demonstrate either to Cigna/New York Life or in court if your internal appeal is not granted to recover your disability benefits.