We recognize the challenges individuals face when dealing with long-term disability denials. We understand the importance of providing clear and concise information to help you navigate this complex situation. In this comprehensive guide, we will delve into the intricacies of long-term disability denials, with a particular focus on how CIGNA Insurance Providers handle such cases.
In 2021 New York Life completed its purchase of CIGNA’s group life, accident, and disability business for $6.3. billion, adding nine million customers and creating a new division called, “New York Life Group Benefit Solutions.” Many of the same employees who had adjudicated claims at CIGNA moved to New York Life. Now, New York Life is one of the largest providers of group disability insurance offered to individuals through private sector employers. These benefits and claims are governed under the Employment Retirement Income Security Act of 1974 (ERISA).
Cigna Long-Term Disability Denials
Long-term disability insurance is designed to offer financial protection and support to individuals who are unable to work due to a qualifying disability. When a person files a claim for long-term disability benefits, they expect their insurance provider, in this case, Cigna, to evaluate their case fairly and provide the necessary assistance. However, it is not uncommon for disability claims to be denied, leaving claimants in a state of uncertainty and financial strain. The denial of a long-term disability claim can be a distressing experience, and understanding the reasons behind such denials is crucial.
Introduction to Long-Term Disability Denials
Long-term disability insurance is designed to offer financial protection and support to individuals who cannot work due to a qualifying disability. When a person files a claim for long-term disability benefits, they expect their insurance provider, in this case, CIGNA, to evaluate their case fairly and provide the necessary assistance. Almost all CIGNA disability policies fall under ERISA. There are some exceptions, where CIGNA has provided group disability coverage to governmental employees. In general, government employees are exempt from ERISA. This is good news.
Yet it is not uncommon for disability claims to be denied, leaving claimants in a state of uncertainty and financial strain. The denial of a long-term disability claim can be a distressing experience, and understanding the reasons behind such denials is crucial.
Common Reasons for Long-Term Disability Denials
For many reasons a long-term disability claim may be denied by CIGNA. It is essential to be aware of these common factors to avoid potential pitfalls during the claims process. Some of the most frequent reasons for denials include:
- Insufficient Medical Evidence: CIGNA requires substantial medical evidence to support a long-term disability claim. Inadequate documentation or medical records that do not sufficiently demonstrate the extent of the disability may lead to a denial. The key to getting paid is to show how medical symptoms impair occupational duties.
- Failure to Meet Definition of Disability: Every insurance policy has a specific definition of disability that an applicant must meet to be eligible for benefits. If the claimant’s condition does not align with CIGNA’s definition, the claim may be denied.
- Pre-existing Conditions: In some cases, preexisting conditions may not be covered under a long-term disability policy. If CIGNA determines that the disability results from a preexisting condition, the claim could be denied.
- Missed Deadlines or Incomplete Forms: Strict adherence to deadlines and accurate completion of forms are crucial aspects of the claims process. Failing to meet these requirements can lead to claim denials.
- Discrepancies in the Medical Information: If the medical information provided by the claimant conflicts with other medical records, CIGNA may deny the claim based on inconsistencies.
To initiate an appeal, follow these essential steps:
- Review the Denial Letter: Carefully examine the denial letter provided by CIGNA. Understanding the reasons for denial will help you address the specific issues in your appeal. Get the claim file from CIGNA. Appealing without first reviewing the claim file is a very bad strategy.
- Gather Strong Medical Evidence: Obtain comprehensive medical records from all relevant healthcare providers to strengthen your case. Ensure that these records demonstrate the severity of your disability and its impact on your ability to work.
- Seek Expert Opinions: Obtaining expert opinions from medical specialists or vocational experts can provide valuable support for your appeal.
- Prepare a Detailed Appeal Letter: Craft a well-structured and persuasive appeal letter that addresses the issues raised in the denial letter and includes the additional evidence you have gathered. Most important, provide the evidence that demonstrates your medical symptoms prevent you from working. The information you provide to CIGNA is more important than the appeal letter.
- Watch Deadlines: Timeliness is crucial in the appeals process. Make sure to submit your appeal within the specified timeframe to avoid further complications.
Understanding CIGNA’s Review Process
CIGNA follows a structured review process when evaluating long-term disability appeals. Here is an overview of the typical steps involved:
- Initial Review: CIGNA will conduct an initial review of your appeal and compare it with the information from the original claim.
- Independent Medical Examination (IME): In some cases, CIGNA may request an IME to obtain an unbiased evaluation of your medical condition.
- Vocational Assessment: CIGNA may assess your ability to work in a different occupation to determine your eligibility for benefits.
- Legal Review: Before you appeal, consider seeking legal counsel to assess your options and advise on further action. Going to an attorney after you have exhausted all appeals may be too late.
Navigating the long-term disability claims process can be overwhelming, especially when faced with a denial. We seek to provide you with accurate and valuable information to help you understand long-term disability denials and how to persuade CIGNA to reverse its decision.
Remember, each case is unique, and appealing a denial requires meticulous attention to detail and thorough documentation. We hope this guide has explained the essential aspects of the process, enabling you to take the necessary steps towards a successful appeal. For further assistance or professional guidance, reach out to Jonathan Feigenbaum today. We are here to support you on your journey to securing the benefits you rightfully deserve.