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How to Avoid Issues When Filing a CIGNA Claim

CIGNA - also known as the Life Insurance Company of North America or LINA - is one of the most active disability insurance companies in the state of Indiana. CIGNA - also known as the Life Insurance Company of North America or LINA - is one of the most active disability insurance companies in the state of Indiana. CIGNA insures disability benefits for numerous large employers in Indiana, including Purdue University, Subaru of Indiana Automotive, and Community Health Network.

If you have filed a disability claim with CIGNA, be aware of the following ways in which CIGNA may attempt to deny your disability claim:

Denial for Failure to Provide Updated Medical Records

During the application process, CIGNA will require you to sign authorization forms that allow them to request your medical records from doctors' offices and hospitals. If CIGNA does not receive a response to its medical records request, it may eventually deny your claim for failure to provide medical records. Be advised that you should urge your treating providers to timely respond to CIGNA's requests for updated medical records. Otherwise, it may result in CIGNA's denial of your disability benefits.

Even after your claim for disability benefits has been approved, CIGNA will request periodic updates of your current medical treatment. If you do not tell CIGNA of your current medical treatment, or if your doctors' offices fail to send medical records to CIGNA, your claim may be denied.  Keep in mind that CIGNA may require you to sign updated medical authorization forms as well.

Obtaining Physician Statements that Support a Denial of Benefits

After you complete your initial disability application, CIGNA will request updated statements from your treating physician(s). Typically, CIGNA will repeatedly ask for your doctor to complete updated statements if medical improvement is expected. CIGNA will compare your doctor's list of work restrictions to the duties and demands of your occupation (or another occupation if you must prove you are disabled from "any occupation"). If CIGNA decides that you can still perform work with the list of work restrictions provided by your doctor, then your disability claim will likely be denied.

Review at the "Any Occupation" Stage

For long term disability claims, it is common for the definition of "Disability" to first require that you are disabled from performing the duties of your own occupation. After a set time period of receiving long term disability benefits, such as 24 months, then the definition of "Disability" changes to require that you are disabled from performing the duties of “any occupation.”  At this time, CIGNA may claim that although you are disabled from your old job, you are capable of working in a different job. This heightened standard of disability makes it easier for CIGNA to deny your claim. 

During its review of this “any occupation” standard of disability, CIGNA may perform a new evaluation, including but not limited to review by a peer reviewing physician, vocational consultant, private investigator (sometimes utilizing video surveillance of claimants), an independent medical examiner, an in-house medical consultant, or a functional capacity evaluation. CIGNA will use a variety of tools to generate evidence that may lead to your denial of disability benefits. Although CIGNA may use any of these review methods during any part of your claims process, it is especially common for CIGNA to utilize them at the any occupation stage of review.

What to Do if You Are Denied:

If you learn that your short term or long term disability benefits have been denied, it is essential to contact Keller & Keller right away for a free consultation. You have a limited amount of time to file a persuasive appeal to support your case. Attorney advice is critical to the success of your appeal and possible litigation

Keller & Keller has experience fighting CIGNA during the disability appeal process and in court. Contact Keller & Keller today for a free consultation about your short term disability or long term disability claim.

 

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