Anyone familiar with LTD Insurance claims and ERISA knows that you must first exhaust your administrative remedies before filing suit. In other words, you have to try and convince the LTD insurer to reverse its decision to deny the claim for benefits. While this may seem like an difficult task since the LTD insurer who makes the claims decision is the same entity that pays the claim, it is not impossible.
SMDA has been fortunate to convince CIGNA to reverse its LTD claims denial decision in several consecutive recent claims.
The first client was experiencing significant back problems as a result of degenerative disc disease. She was unable to continue her job as a customer service representative for a dental services company. The second client had a number of medical problems including pretty severe carpal tunnel syndrome which caused problems with any repetitive hand movements. Unfortunately, she was unable to do her job which required non-stop typing.
SMDA convinced CIGNA to retroactively reinstate each of these LTD insurance claims and place the clients back on claim. This demonstrates the importance of properly preparing the administrative appeal with the end result of getting the client’s benefits paid.