Friday, August 8, 2014

Federal Court Reverses CIGNA

U.S. District Court Judge Bianco reversed the termination of long term disability (“LTD”) benefits yesterday by CIGNA. CIGNA claimed that it could terminate my client’s LTD benefits because he did not submit “time concurrent” evidence of disability. CIGNA’s in house shill, Dr. John Mendez, said that evidence was “time concurrent” if submitted within one month of CIGNA’s termination decision. 

Mendez testified at his deposition that the need for “time concurrent” evidence to establish disability was based on his “clinical experience, expertise, and knowledge.” Gary Person, who supervises CIGNA disability appeals, admitted during his deposition that neither the Policy, nor any other CIGNA document, required “time concurrent” evidence to establish disability. Judge Bianco accepted my argument that since CIGNA’s Disability Policy did not state that “time concurrent” evidence was required, it could not provide a basis to terminate Plaintiff’s LTD benefits. 

Judge Bianco also agreed that CIGNA failed to identify any affirmative finding that the claimant’s condition improved to justify terminating LTD benefits. Since CIGNA had previously found the claimant was disabled, Judge Bianco found the claimant remained disabled because CIGNA terminated LTD benefits based upon a purported absence of evidence, as opposed to affirmative evidence showing the claimant got better. Judge Bianco added that implying that the claimant had improved because he took an overseas trip was unpersuasive selective cherry-picking.

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