A Federal Judge in Nevada has granted judgment to a Long Term Disability insurance claimant in her claim against CIGNA/LINA, following a bench trial. The court ruled for the claimant, notwithstanding its finding of fact that CIGNA administered the determination of eligibility in an appropriate manner. Instead, the court determined that CIGNA did not properly terminate the claim for benefits under the any occupation definition of disability.
The claimant, who had worked as a reservations manager for VEBA, a sedentary position, stopped working in 2006, to undergo surgery to remove a tumor pressing against her brain stem. She returned to work, in February 2007, on a reduced basis, but was unable to continue after August 2007. She remained on claim throughout her own occupation period, and CIGNA commenced with an analysis of her ability to engage in any occupation.
CIGNA sought and obtained an examination of the claimant, having her undergo a neuropsychological evaluation in October 2011. CIGNA then conducted a Transferable Skills Analysis (TSA), which purported to identify occupations the claimant could perform. Her claim was then closed, and the claimant appealed, providing additional medical support. CIGNA on appeal relied upon one of its in house medical personnel, Dr. Hall, and the appeal was denied.
In its de novo review, the court determined that CIGNA's decision was improper, as CIGNA had determined that the claimant had the "ability to perform the duties of any occupation", but had not reached the important question of whether the claimant was disabled under the terms of the policy, meaning that she was able to earn 60% of her prior earnings.
We see flawed Transferable Skills Analysis from CIGNA and other insurers regularly in the context of long term disability insurance claims. The TSA's very often only reflect the limitations set forth by the insurers' hired doctors and fail to consider the limitations or restrictions of the claimant's treating doctors.
Brown v. CIGNA