CIGNA'S LONG TERM DISABILITY DETERMINATION ARBITRARY AND CAPRICIOUS
A Federal Court has determined that CIGNA abused its discretion in terminating a claim for long term disability insurance benefits, for a claimant with orthopedic problems and other co-morbid conditions. The Court determined that CIGNA improperly determined the extent of the claimant's functional capacity, and relied upon a flawed transferable skills analysis to decide that the claimant could work in some occupation.
The claimant suffered from diabetes, back problems, sleep apnea, and heart disease, and was forced to leave work due to his disability. He was awarded Social Security disability benefits, which were pursued as a result of his CIGNA policy requiring that he pursue these benefits. CIGNA sought to rely upon a report from the claimant's treating doctor, but misinterpreted the opinions of the doctor, and erroneously determined that the doctor provided a greater level of functionality for the claimant.
By misinterpreting this material and utilizing these findings to perform a transferable skills analysis, CIGNA's claim determination lacked substantial evidentiary support. The Court thus determined that the claimant remained totally disabled and awarded the payment of all back benefits, with interest on these benefits and attorneys fees to be awarded.
The mis-classification of medical evidence is a common technique of insurance companies considering the continuation of long term disability insurance benefits. When this occurs, the transferable skills analysis will also be flawed, and could lead to the wrongful termination of one's benefits.
If you have a long term disability insurance claim, take efforts to ensure that your doctors are appropriately articulating your functional deficits. If you feel concerned about your claim, feel free to contact our firm to see how we can help assist you.
Wykstra v. Life Ins. Co. of N.A. (CIGNA)