SMDA was hired by a Michigan family to compel an insurance company to pay Long Term Care benefits for their elderly mother who had been receiving care at a Long Term Care facility. The family had purchased an insurance policy to help defray the cost of care for their mother…
SMDA recently obtained a reversal of CIGNA’s decision denying Long Term disability Insurance Benefits to a Henry Ford Hospital employee. As a result of our comprehensive administrative appeal CIGNA (aka Life insurance Company of North America) overturned its decision denying our client’s claim for benefits. Our client suffered from a…
Many of our client’s think that they are entitled to Long Term Disability Insurance benefits because they are no longer able to do their job as a result of an illness or injury. What they don’t understand is that the Disability Insurance companies have fabricated a hurdle that can sometimes…
It can be confusing trying to figure out the amount of Long Term Disability Insurance benefits the insurance company should pay. Here is a brief outline of how the amount is commonly determined. Step 1.-Figure out your base monthly income. (Take your yearly income and divide by 12. Beware however-commonly…
The team at SMDA recently obtained a favorable administrative decision reversing Cigna’s (Life Insurance Company of North America) decision denying disability insurance benefits for a Registered Nurse who had been disabled by her treating physicians as a result of her significant orthopedic (back and shoulder) problems. The original denial was…
SMDA recently convinced LTD insurer Cigna to overturn its claims denial decision for a registered nurse who developed significant low back pain that prevented her from performing her own occupation. Our client had degenerative disc disease that had progressed over the years eventually leaving her unable to work. Cigna initially…
SMDA recently convinced Cigna (Life Insurance Company of North America) to overturn a claims denial decision for an individual who is suffering from significant cognitive deficits as the result of some as yet undiagnosed condition. SMDA prepared a comprehensive administrative appeal of the claims denial decision including neuropsychiatric testing which…
Almost every Long Term Disability Insurance Policy I have ever reviewed contains a limited period (usually 24 months) of time that it will pay benefits if a claimant is unable to perform the duties of his/her “Own” (see prior post on how “Own” occupation is misleading) occupation. The plans most…
I was recently asked to review a claim denial by a well know disability insurer for a nice lady who suffered a terrible crush injury to her foot. She had worked at a production facility where her job duties required her to be on her feet for extended parts of…
In this recent case out of Louisiana the court rejected Cigna’s (Life Insurance Company of North America) efforts to deny a claim by a man who was permanently paralyzed and wheelchair bound. The claimant, Mr. Hughes, had been employed as an electrician when he was forced to stop working as…