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Your Disability Benefits Have Been Denied Or Terminated By Cigna/LINA. 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/LINA.

Disability benefit claims denied by Cigna/LINA often follow a common pattern. Sometimes Cigna/LINA denies disability benefits because you or your doctors did not complete and submit to Cigna/LINA 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/LINA denies disability claims without paying any benefits or after paying only short-term disability benefits. A common Cigna/LINA practice in such denials is that Cigna/LINA 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/LINA 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/LINA will often terminate disability benefits with just a few months of “own occupation” benefits to be paid. Another common pattern is that Cigna/LINA terminates benefits after paying all the “own occupation” definition of disability benefits.

Often Cigna/LINA 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/LINA claims you can do a similar job. Most Cigna/LINA policies define “your occupation” not as what you actually do for your employer but what people doing similar jobs generally.

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

When Cigna/LINA denies or terminates benefits it invites you to request a review and file and “appeal.” Typically, after the appeal is submitted Cigna/LINA 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/LINA 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/LINA ever requesting new medical records – just an annual statement from you and your doctor that you continue to be disabled. But then Cigna/LINA terminates your disability benefits even though you have never gotten better.

Cigna/LINA 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/LINA will require that you attend an “independent medical examination” or a “functional capacity evaluation.” Often Cigna/LINA 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/LINA uses a great many in-house doctors and nurses to evaluate claims; their reports and opinions are almost always one-sided. Cigna/LINA will often send claimants to independent medical examinations during the course of an appeal and sometimes before the appeal. Cigna/LINA 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/LINA 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/LINA sends you to an independent medical examination; Cigna/LINA then sends you the reports from its independent medical examination and other medical reviews; you respond; your appeal denied – but Cigna/LINA offers you a second voluntary appeal, and the process starts again.

Cigna/LINA 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/LINA 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/LINA didn’t ask for records are submitted to Cigna/LINA 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/LINA 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/LINA’s common practices. We know what evidence you need to demonstrate either to Cigna/LINA or in court if your internal appeal is not granted to recover your disability benefits.