In August 2014 our client for this long term disability appeal, a network planner/installer, was injured in a surfing accident. He developed chronic, debilitating pain and applied for disability benefits under his employer’s ERISA long-term disability policy. After being denied, he appealed internally on his own but was once again denied. The plan afforded a second “voluntary” appeal and he retained counsel for that appeal.

Our ERISA administrative long term disability appeal argued:

  • CIGNA had not given our client the full and fair review guaranteed under ERISA
    • the file was not reviewed by an appropriate healthcare professional
  • A reasonable fiduciary could not simply ignore the well-documented complaints of pain and the opinions of the treating physicians regarding the debilitating nature of our client’s condition
  • CIGNA had not made a proper assessment of our client’s occupational duties, instead merely labeling the occupation “sedentary”

CIGNA reinstated benefits with an expected lifetime value of the monthly benefits totaling to $947,394.