Our 50-year-old client worked in upper management for a multi-media advertising agency as a Senior Buyer of advertising. Her job had significant financial pressures, quotas, and a constant need to hit numbers. After she began suffering unexpected but intensely debilitating back pain, she was not able to continue to travel for business and was confined to local work, which was also difficult, and resulted in a marked decline in performance. On top of this, her condition required significant medical care, including chiropractic and physical therapy, leaving little time to get work accomplished. Those issues were not considered during the claim process by CIGNA. Care and treatment to a level that interrupts multiple work days per week must be a factor considered.
She was suffering from numerous disabling orthopedic conditions, including multiple failed back surgeries, L4-L5 and L5–S1 lumbar fusions, lumbar radiculopathy, and chronic bilateral low back pain. She still suffers daily from symptoms, restrictions, and limitations, including chronic pain, erratic gait, numbness and tingling, weakness, cramping, joint and muscle pain, back pain, and musculoskeletal problems that impact and impair both her daily life and her ability to work.
To support the claim, we ensured that our client consulted a number of medical professionals for evaluation, treatment and claim support for her conditions. We worked to gather this support with our client, who needed much assistance in the process. With our collaboration, all of her doctors were extremely supportive of her disability insurance claim and provided strong articulations of her functional deficits.
As is typical, CIGNA had initially denied the claim, based on a nurse review, refusing to consider the well documented complaints. Once her claim had been denied, she engaged Jason Newfield to battle on her behalf, and fight her claim on appeal, which was accomplished in a team approach with the client and her medical providers. Using our formula for success, we were able to submit an appeal to overturn CIGNA’s wrongful determination.
We created this successful appeal for our client, developing medical, vocational, factual, and legal support, and overwhelmed CIGNA with this powerful array of support showing why our client could no longer work on a full-time sustained basis in both a physically and cognitively demanding career. Her functionality had been too compromised, and we were able to demonstrate this to CIGNA.
With our client’s support, we also worked with her physicians in guiding them on issues to focus upon in order to rebut CIGNA’s medical portrayal of the issues. The medical review performed on behalf of CIGNA was both inaccurate and unreliable. We went through the issues and each and every position advanced, in an effort to undercut the foundation of the claim decision.
Our appeal on our client’s behalf contained significant support, including medical narratives from her doctors, forms, subjective medical support, and medical literature addressing many of the issues presented and how they impact – guiding CIGNA as to the severity of our client’s conditions.
With this array of support, we convinced CIGNA to accept further liability and pay benefits to our client. Shortly after our appeal was submitted, CIGNA reversed its decision. Our client remains on claim, with light monitoring of the claim. Our approach and process, combined with our years of experience identifying the weak areas in CIGNA’s claim decision, led to a successful appeal, and payment of our client’s claim.