In this video, disability lawyers Gregory Dell and Alex Palamara discuss Mr. Palamara’s recent win on appeal of long-term disability benefits from Cigna on behalf of a registered nurse who suffered from disabling back conditions including spinal stenosis and degenerative disk disease. Shortly after Cigna’s decision to award benefits, it made a buy-out settlement offer.
The nurse, an employee of Trinity Health Care, was disabled from working in her own occupation and on claim for two years. When the definition of disability changed to requiring her to be unable to work in any gainful occupation, Cigna denied her claim. The denial was based on the opinion of physicians, employed by Cigna, who only reviewed her medical records. None of them ever examined her or conducted any tests.
On appeal, her medical records were updated and a functional capacity evaluation (FCE) was performed. The FCE report found she could not work even in a sedentary capacity. Cigna reversed its decision and awarded her long-term disability benefits.
Shortly after, Cigna offered to buy-out the policy and offered her a lump sum settlement. The disadvantage of accepting a settlement is that she will receive a little less money than if she stayed on claim until the age of 65. The advantage is that just winning on appeal does not mean that Cigna cannot again terminate her benefits, so she would have to again fight to have them reinstated. Accepting a lump sum settlement takes away the constant stress of waking up every day and wondering if this is the day that benefits will be terminated.
If you have questions about this, or any other aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free case consultation.