Long Term Disability Law Blog
Disability Insurance Companies are no strangers to lawsuits. Hence, it is not uncommon to find Disability Insurance Companies sometimes facing multiple lawsuits in a single week. In fact, during the fourth week of May 2011, the CIGNA Group Insurance (CIGNA) had three lawsuits filed against it by individuals who were dissatisfied with the way CIGNA handled their claims for disability benefits.
The First Case – Alamaba Disability Lawyer Files Disability Insurance Lawsuit :
The first case was filed by an Alabama disability attorney for a former employee of the Liberty National Life Insurance Company at the District Court for the Northern district of Alabama. In Patricia Wielicki V CIGNA Group Insurance, the plaintiff Patricia Wielicki through her employment was a participant of a long term disability insurance plan that was administered by CIGNA. The plaintiff filed a claim for long term disability (LTD) benefits and was initially denied on May 18th 2010. Her appeal against CIGNA’s initial decision was also denied on August 17th 2010. In the lawsuit, the plaintiff alleged she was unable to perform the duties of any gainful occupation and CIGNA’s decision to deny her claim for LTD benefits was arbitrary and capricious and not supported by any evidence. Having exhausted all her administrative remedies, the plaintiff is seeking from the Court the following relief:
- A review and reversal of CIGNA’s denial decision;
- Additional relief as permitted by law;
- An award of reasonable attorney fees and costs;
- Clarification of the plaintiff’s rights to future benefits under the employee welfare benefit plan;
- Recovery of any and all benefits that the plaintiff is due under said plan that have not been paid;
- That CIGNA be ordered to pay such other damages as may be permitted by law.
The Second Case – Indiana Disability Lawyer Sues Cigna for Disability Benefit Denial:
In Jeffrey Maxwell v Subaru Of Indiana Automotive Inc., d/b/a Subaru Of Indiana Automotive Inc. Short-Term Disability Income Benefit Program, CIGNA Corporation, d/b/a CIGNA Group Insurance, And Life Insurance Company Of North America, A Subsidiary Of CIGNA Corporation, the plaintiff through an Indiana disability lawyer filed the lawsuit against CIGNA and other relevant parties at the Tippecanoe County Superior Court. In this case, the plaintiff was an employee for Subaru in Tippecanoe County until he was terminated on May 1st 2010.
Prior to the plaintiff’s termination, the plaintiff was an eligible participant in Subaru’s Disability Plan, which was offered, managed, administered and operated by CIGNA. Due to migraine headaches experienced by the plaintiff, he was prevented from being able to perform his regular work duties at Subaru. Consequently, he applied for short-term disability benefits under the Policy. The plaintiff supplemented his claim with a certification from medical doctor, who concluded that the plaintiff was incapable of performing even sedentary activity as a result of the migraines.
On June 3rd 2009 and November 24th 2009, Subaru, through its agents, denied the plaintiff’s claim for short-term disability benefits. The plaintiff claimed in the lawsuit that he was entitled to short term disability benefits and Subaru had breached the terms of the Policy by wrongfully denying his claim for short-term disability benefits. Consequently, the plaintiff alleged that he had suffered damages including the loss of short-term disability benefits, other lost benefits, costs, attorney’s fees, and other damages.
The plaintiff also timely applied for LTD benefits as a result of him suffering from migraines. However his application for LTD benefits was also denied by CIGNA on February 9th 2010 and November 1st 2010 on the ground that there were no measured limitations that supported off work status in his application. The plaintiff argued that CIGNA had:
- Failed to consider the opinion of every doctor that personally examined Plaintiff and concluded that he was disabled;
- CIGNA demanded objective tests to establish a condition that often cannot be confirmed by objective testing;
- CIGNA refused to have Plaintiff examined, in person, by a physician or vocational expert, and failed to engage in any meaningful dialogue with Plaintiff;
- CIGNA breached its fiduciary duty and ignored a conflict of interest by acting as the funding source and the administrator of the Plan;
- CIGNA denied Plaintiffs claim in bad faith without producing any credible evidence to refute all of the treating physicians, and a vocational expert, who concluded that Plaintiff was disabled.
Relief Sought By the Plaintiff
The plaintiff alleged that from May 1,2009 though October 28, 2009, and at all relevant times the plaintiff had been incapable of working at Subaru, was qualified as disabled under the Plan, was entitled to LTD benefits under the Plan, and CIGNA breached the terms of the Plan by wrongfully denying LTD benefits. As such, the plaintiff argued that CIGNA’s denial of LTD benefits under the Plan was arbitrary, illegal, capricious, unreasonable, discriminatory, was not made in good faith and clearly violates ERISA, on multiple grounds. The plaintiff therefore seeks the following relief from the Court:
- Judgment against CIGNA in an amount which will fully and fairly compensate him for each and every element of damages allowed under ERISA;
- For costs and attorney’s fees;
- And all other relief just and proper in the circumstances.
This case will probably be removed to federal court as it is governed by ERISA.
The Third Case: Michigan Disability Lawyer Sues Cigna for Disability Benefit Denial
In Lyle Zeigler v CIGNA, d/b/a CIGNA Life Insurance Company of North America, the plaintiff Lyle Zeigler filed his complaint through a Michigan disability attorney at the District Court for the Western District of Michigan. The action arises out of the issuance and breach of disability insurance policy by CIGNA.
The plaintiff here in this case was employed by Champion Paper/Verso Paper as an electrician/instrument technician and was covered by a disability insurance policy issued by CIGNA. Under the policy, the plaintiff was entitled to monthly LTD benefits if an injury or sickness prevented him from doing his job. It specifically defined that:
“The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is: 1. Unable to perform the material duties of his or her Regular Occupation; and; 2. Unable to earn 80% or more of his or her Covered Earnings from working in his or her Regular Occupation.
After Disability Benefits have been payable for 24 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is: 1. Unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and 2. Unable to earn 60% or more of his or her Indexed Earnings.”
The plaintiff was suffering from meralgia paresthetica, a condition which causes significant balance problems and numbness in his legs and hips, as well as severe degenerative disk disease in his lower and upper back and neck. And since July 25th 2007, he had been unable to work due to his medical conditions.
All the time, the plaintiff had submitted medical documentations that supported his claim for LTD benefits and satisfied the definition of disability in the LTD policy. CIGNA nevertheless terminated LTD benefits to the plaintiff on September 23rd 2009. The plaintiff appealed and exhausted his administrative remedies when CIGNA issued a final denial on April 22nd 2010.
In the lawsuit, the plaintiff claimed that under the policy he was entitled to LTD benefits until the age of 67. The end result of CIGNA’s action had resulted in the plaintiff suffering damages in the form of past and future disability benefits not paid, together with interest on that sum. As such, the plaintiff is seeking judgment against CIGNA:
- For an amount of money which will fully compensate him for losses sustained;
- For costs, disbursements, and attorney fees;
- For such other and further relief as the court deems just and equitable;
- For a determination outlining his future rights under the terms and conditions of the disability policy from CIGNA;
- For an amount of money which fully compensates him for his injuries and losses;
- For an award of punitive damages.
The plaintiff also stated in the lawsuit that he demanded trail by jury.