How to Appeal a Cigna Coverage Denial

Many people rely on disability insurance to help cover expenses in the event of a short or long-term disability. Long-term disability insurance is necessary for many people who do not have sufficient savings to function as a safety net alone.

Despite the necessity of disability benefits, policyholders may find themselves without necessary benefits after a claim denial.

What is Cigna Coverage?

Cigna is an insurance provider based in Bloomfield, Conn. A major product that the company offers is disability insurance. Cigna offers both short-term and long-term disability coverage.

Cigna disability coverage is designed to replace a portion of a person’s earnings if they are unable to work due to a disability. Typically, short-term disability coverage will cover a higher percentage of a person’s lost wages, but for a shorter length of time. Short-term disability plans usually cover a period of months to a few years.

In contrast, long-term disability may cover an ongoing condition. However, long term disability plans typically cover a smaller percentage of a person’s income. Long term disability plans may cover someone for 10 years, or until they reach retirement.

According to the Council for Disability Awareness, approximately 25% of 20-year-olds will become disabled at some point before they retire. Common reasons for requiring disability insurance include heart disease, cancer, and back problems. The average length of time for long term disability claims is about three years, but approximately one in eight workers experience a disability that leaves them unable to work for at least five years.

Despite the risk of becoming disabled, the Council for Disability Awareness says that at least 51 million working Americans don’t have disability insurance beyond what is provided by Social Security benefits.

Even worse, most Americans aren’t financially prepared for a disability. Only 48% of Americans report that they could cover three months of expenses after becoming disabled. Similarly, nearly half the country can’t cover an unexpected $400 expense without serious financial consequences such as taking out a loan or selling something to cover the costs.

Unfortunately, a long term disability could pose significant issues for Americans – even the Americans who can cover three months of expenses. Although three months is a good start, long term disabilities last for an average of 34.6 months. With the benefits of long term disability insurance, these months can go from insurmountable to manageable.

What is the Cigna LTD Policy?

Cigna offers a range of long term disability policies designed for groups as well as individuals.

Many workers are offered disability insurance through their employer. If your employer offers a basic level of Cigna coverage for long term disability, and you file a valid claim, you will be eligible for a monthly benefit of up to 60 percent of your regular monthly earnings. This level of compensation will allow you to have up to $4,000 per month in disability coverage. The benefits you receive may be taxable.

The benefits do not take effect until six months after a person becomes disabled. During this time, you must go through an “elimination period” to determine if you are disabled by definition. This will involve being treated by a physician who determines that you are indeed disabled and unable to work. 

Eligibility to receive benefits from a Cigna LTD policy depends on your ability to continually prove that you are still disabled. If you fail to be able to do so, you may lose your benefits. 

If you have applied for Cigna coverage and disability benefits, you may want to be careful to follow your doctor’s orders regarding your mobility and activity levels. Many disability insurance providers hire private investigators to conduct covert surveillance on disability applicants.

This surveillance is meant to ensure that the people receiving disability benefits are actually disabled and aren’t faking it. In order to ensure that you are not photographed or recorded doing activities that you have claimed your disability makes it impossible for you to engage in, you may want to follow your doctor’s orders, even on days when your disability isn’t flaring up.

Additionally, you may want to be aware of what you post on social media during this time as well. Some disability insurers may monitor applicants’ social media accounts to ensure they are not lying about their level of ability.

Effectively making a claim for long-term disability coverage often comes down to having the appropriate documentation in place. This means that to file a claim and to continue proving disability, a benefits applicant must provide extensive documentation to prove that they were disabled and that the disability affects their work and ability to earn an income.

Documentation comes in the form of paperwork and medical records, as well as forms the company requests. Documents commonly used in the claims and appeals process include: 

• Claimant statement: This statement includes information about the claimant including information about their disability
• Employer statement: A description of the claimant’s job and how their disability impacts their job performance
• Physician’s statement: Information from the claimant’s doctor including detailed information about the medical disability and how it affects them
• Family statements: Claimant’s family members and close friends can provide statements about how they’ve seen the claimant’s disability affect them
• Unfortunately, even if the claim provides a significant amount of documentation, Cigna coverage may be denied – sending the claim to appeal.
  

  What is the Cigna LTD Appeal Process?

  There are a number of reasons a claim may be denied. If you file a claim for long-term disability benefits from Cigna or another insurer and your claim is denied, you are not out of options. An applicant may contact their case manager to check the status of benefits information. This will hopefully provide more information on whether your case is still being processed, if it may have been denied, or if it has been delayed.

  If a claim for benefits has been denied, the applicant will be notified by mail. The denial will outline the reason the claim was denied. If a claim is denied, a policyholder has the right to file an appeal. Information on the appeal process will be provided in the denial letter, along with the deadline by which an applicant must file the appeal.

  Reading the denial letter carefully can help an applicant file the strongest appeal possible; addressing each perceived weakness in the initial benefits claim helps the appeal. It should also correct any identified errors in the initial claim, as well as provide additional documentation.

  Before submitting an appeal, an applicant often does what is known as “stacking the administrative record.” This is a process in which the insured adds as much evidence as they can to their administrative record before they appeal. This is done prior to appealing because once an appeal is processed, an applicant is no longer allowed to add records or alter their file.

  Should You File a LTD Lawsuit?

  Filing a Cigna LTD lawsuit may be a good path forward if all other options have been exhausted. If an initial benefits claim was denied and an appeal is similarly unsuccessful, a policyholder may file a long-term disability benefits lawsuit in the hopes of receiving benefits after a disability-causing incident.

  News sources have reported on Cigna, Unum, and other insurance companies that policyholders claim unfairly denied benefits, even if the claimants effectively proved that they were disabled and submitted claims on time. 

  CBS Chicago reported on a Cigna policyholder who said that he was permanently disabled due to a heart condition but was denied his disability benefits three times. Now, the man is without a paycheck and unable to work.

  Policyholders who believe that they are in a similar situation and have exhausted the appeals process may file long-term disability insurance lawsuits to try to get the benefits they deserve. A specialized lawyer can assist with the process.