Woman with Multiple Diseases Sues Cigna for Denying Benefits
By Amanda Antell
Plaintiff Marlisa Deaton is suing Cigna Group Insurance for wrongfully denying her long-term disability benefits after she was no longer able to work.
Originally, Deaton was a full-time employee of FMR LLC. She held the position as a Transaction Processing Representative III until February 26, 2012, when she had to quit work due to various medical complications. According to the Cigna lawsuit, Deaton’s multiple illnesses and co-morbidities have left her unable to work since the time she had to leave her job at FMR LLC. Her debilitating conditions include lumbosacral arthritis, thoracic, lumbar and cervical sprain, fibromyalgia, bulging discs in her neck, bilateral knee surgeries, lower lumbar problems and numbness in the shoulders or arms.
Under her former employer’s full-time benefits package, Deaton was eligible to receive the Employee Welfare Benefit Plan, which provided group disability benefits to employees of FMR LLC. This plan was supposed to provide the plaintiff with either short or long-term disability benefits, the lawsuit says.
Cigna Disability Claim Denial Overview
After Deaton applied for long-term disability benefits, Cigna replied with a letter dated August 23, 2012, stating that she was denied based on the lack of “clinically measured deficits” impacting her ability to do her typical occupation tasks in her job. She had also applied for short-term benefits several times for different medical reasons, but had also been denied, stating that she did not meet Cigna’s requirements.
At this time, Deaton is now disabled and her medical condition is deteriorating. With her worsening medical conditions, she applied once again for long-term disability benefits, but was again denied. In her disability claim denial lawsuit, she says that Cigna’s failure to give her benefits despite medical records is a violation of state and federal law, according to ERISA and the Social Security Act. Deaton is currently receiving Social Security benefits.
Cigna did not give specific medical reasons for why they denied the plaintiff long-term benefits, and failed to reference her Social Security approval in their denial letter, according to the lawsuit. Legally speaking, Cigna or any other insurance company would be required to give a complete report of a thorough review of Deaton’s case, and would only be able to deny her benefits if they had reasonable medical evidence. However, they are not allowed to use third-party opinions due the discretion rights of the patients, as well as not having the excuse to take any case at face value.
According to court evidence, Cigna did just that by relying on the statements of hired reviewers who were certified in specific areas of medicine. However, their medical specialties did not pertain to the medical conditions that are relevant to Deaton. Despite this fact, Cigna still treated these statements as medical evidence that lead to their conclusions. Deaton is suing Cigna to reclaim her benefits, as well claim compensation for the missing payments from each month, plus additional interest and other punitive damages.
The disability insurance claim denial lawsuit is Marlisa Deaton v. Cigna Group Insurance, Case No. 2:13-cv-00147-WOB-CJS, in the U.S. District Court for the Eastern District of Kentucky, Northern Division of Covington.
File a Disability Claim Denial Lawsuit
If you believe that you or a loved one have been the victim of a Cigna insurance claim denial, you have legal options. Please visit the Unum and UnumProvident Disability Insurance Claim Denial Class Action Lawsuit Investigation. There, you can submit your claim for a free legal review and if it qualifies for legal action, a seasoned lawyer will contact you for a free, no-obligation consultation. You will be guided through the litigation process at no out-of-pocket expenses or hidden fees. The claim denial attorneys working this investigation do not get paid until you do.
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