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Appealing a Denial of Disability Benefits from Cigna

Osterhout Berger Daley Law > Insurance Companies > Appealing a Denial of Disability Benefits from Cigna

Getting a disability insurance policy from Cigna can offer workers the ability to protect themselves financially if they are temporarily or permanently disabled and unable to return to their jobs. It can be very disconcerting when you file a claim for your disability benefits only to be denied. The experienced disability lawyers at Osterhout Berger Disability Law are available to help you to appeal your denial of benefits from Cigna.

What is Cigna?

A global health company, Cigna is headquartered in Philadelphia, Pennsylvania and employs around 40,000 people. The company was formed in 1982 from the merger of INA Corporation and Connecticut General Life Insurance Company. It offers health plans that include disability insurance, medical insurance, dental insurance and behavioral health care products.

Disability Insurance from Cigna

Cigna offers short- and long-term disability products to employees through group plans. Short-term disability policies through Cigna offer workers a percentage of their income for a limited duration after their disabling conditions have forced them to miss the elimination period time. Long-term disability benefits are offered to employees who have the policies and who are disabled for long periods. These benefits also replace a percentage of the workers’ incomes while they are unable to return to work. Some employees purchase both types of policies from Cigna. This allows them to go for a shorter period of time without pay than they might otherwise.

Cigna short-term disability

If you meet your company’s eligibility requirements for coverage, you can participate in Cigna’s short-term disability program. You’ll have to go through a waiting period before your coverage begins. You’ll want to apply to enroll in this program as soon as you’re eligible to avoid the risk of not being covered in the event you become disabled. The longer you wait to enroll, the longer it’ll take to receive benefits in case you find yourself needing them.

Cigna defines a disability as an injury or sickness that leaves you unable to perform regular tasks at work and leaves you unable to earn at least 80% of your income. You’ll have to have a physician provide proof of your disability in order to qualify for benefits. The benefits under short-term disability typically covers up to 60% of your weekly paycheck. Keep in mind that other income benefits may impact the amount this plan will cover. Other income benefits may include Social Security disability, any pay that your company provides for sick leave, and/or any payments received from a settlement, judgment, or arbitration. If you qualify to receive benefits, you will be able to collect payments until the end of 13 weeks or until you’re deemed unqualified to continue receiving benefits. The decision to end your disability benefits will depend on which of the two options comes first. Your company may ask for continued proof of disability and may have the right to determine when you’re no longer qualified to receive benefits. It’s important to keep account of your medical records and follow treatment as prescribed so as not to give your company any reason to terminate your benefits early unnecessarily.

Cigna long-term disability insurance

Long-term disability insurance from Cigna is similar to their short-term disability with a few differences. The elimination period is longer, benefits are paid monthly, and the amount is greater than it is with the short-term disability plan. The elimination period with Cigna’s long-term disability plan is six months. The benefit amount is the lesser of 60% of your monthly income or $4,000 per month.

The same requirements that are set for the short-term disability plan, apply to the long-term disability plan. You’ll have to go through the elimination period, be under the care of a physician, and meet the definition of disability. You may also have to continuously provide proof of disability in order to continue receiving benefits. If you fail to meet those or any other requirements set forth by policy and/or your company, your benefits may be terminated. Just be sure to keep record of all paperwork and medical records to ensure that your benefits aren’t prematurely terminated.

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What you need to know about Cigna claims

Most companies have a financial interest to make money and Cigna is no exception. The company makes money by collecting premiums, but they can make even more money by not paying benefits to all of their policyholders. The reality is, most insurance companies have a habit of delaying or denying claims. This doesn’t happen to everyone and it doesn’t have to happen to you. Make sure you fill out your claim form completely and accurately. If your claim is delayed, follow up with Cigna. Finally, if your claim is denied, file an appeal in a timely manner.

How to submit a disability claim to Cigna

You can submit and file a disability claim online or you can print the short-term or long-term disability forms and fax, email, or mail them to Cigna. The short-term disability form has three sections that need to be filled out: one section that is to be filled out by the employer, one section that is to be filled out by the claimant, and one section that is to be filled out by the attending physician. The long-term disability form is a little shorter with just two sections: one section that is to be filled out by the employee and the other to be filled out by the employer. Once the form is submitted, you may receive a call from a Case Manager that will answer any questions you have and let you know what will happen next.

What to do if Cigna delays your claim

If you feel as though your claim is being delayed, contact your Case Manager to check the status. If you feel as though your Case Manager is giving you the run around, you may need to result to something a bit more drastic. Contacting a disability lawyer with experience in this area may be your next best course of action. There have been cases where insurance companies delay claims for insufficient reasons and an experienced disability lawyer can cut through the excuses and move the claim along so that you can start receiving the benefits you need.

What to do if Cigna denies your claim

If Cigna decides to deny your benefits claim, you will be notified by mail. Your denial notice will tell you why the company denied your claim and how you can appeal its decision. There will be a deadline in your letter by which you must file your appeal. If you miss it, you will not be able to try to recover your benefits from Cigna in the future.

Appealing a Denial from Cigna

If you are denied, you might benefit by getting legal help from the experienced attorneys at Osterhout Berger Disability Law. Your lawyers will want you to ask for a copy of your claim file from Cigna. The file will include all of the evidence that the insurance company used as reasons for denying your claim. Bring your file copy and your letter into our office for your appointment.

After reviewing the information, your knowledgeable lawyer may advise you to do several things. He or she will want to help you to add evidence that is favorable to you to your file. When you add more evidence to your claim file, it will be likelier that you will be successful with your appeal. For this reason, your attorney may tell you to submit to additional evaluations and medical exams. He or she may also want you to get more objective tests such as MRIs, lab tests or x-rays. Finally, your lawyer may ask you to get written statements from your doctor and your acquaintances about the limitations that your condition has on your ability to perform the daily tasks of your life and of your job.

By listening to your knowledgeable lawyer and following through what you are asked to do, you may help him or her in the effort to win your appeal. If the company denies your appeal, your attorney may then file a lawsuit against Cigna in court. Contact the experienced disability lawyers at Osterhout Berger Disability Law today to schedule your consultation.

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    Learn more about long term disability insurance, as well as appealing denials and how an attorney can help. These five articles will cover the basics: