CIGNA Disability Claim Denied: Appeals and Your Rights
Author: Ian C. Langtree - Writer/Editor for Disabled World (DW)
Published: 2011/04/19 - Updated: 2026/01/11
Publication Type: Informative
Category Topic: Claims - Related Publications
Page Content: Synopsis - Introduction - Main - Insights, Updates
Synopsis: This report details a successful appeal of a wrongfully denied CIGNA long-term disability claim, providing critical insights for individuals facing similar challenges. The case study demonstrates how insurance companies sometimes use biased medical reviewers, incomplete record analysis, and outdated occupational databases to justify claim denials. This information proves particularly valuable for people with disabilities who need to understand their rights when facing insurance claim denials, as it outlines specific deficiencies in CIGNA's review process - including the use of "independent" reviewers from a sister company and doctors who consistently ruled against claimants. The documented reversal shows that with proper medical documentation, detailed job analysis, and strong advocacy, denied claims can be successfully challenged - Disabled World (DW).
Introduction
Our client is a 52-year-old management consultant who suffers from early onset dementia, early onset Alzheimer's, degenerative disc disease, osteoarthritis, obesity, hypothyroidism, hypertension, hyperlipidemia, vitamin D deficiency, fatigue, fibromyalgia, sleep apnea, migraines, depression, anxiety, TMJ disorder, and plantar fasciitis.
Main Content
His long-term disability insurance carrier, CIGNA, denied his claim for benefits in April 2010. We appealed the decision based on the following:
Our client's work was rapid, detail rich, and time critical, with significant amounts of human interaction in a stress-filled, fast-paced, cognitively demanding work environment. Almost every hour presented new problems and dynamics that required continuous re-thinking, re-assessment, re-grouping, and re-planning. CIGNA never did a proper vocational analysis and relied solely on the physical aspects of the job. Management consultants and steelworkers do not have the same physical challenges, although both require strong mental capacity and the ability to make quick and critical decisions.
CIGNA completely and utterly failed to take all the client's physical AND mental disabilities into consideration. In another area of the law, that would be deemed bad faith.
When the initial review of records was done by CIGNA's medical personnel, not all records were available and the medical personnel were told to decide without the missing records. That's not just sloppy workplace behavior - that's intent to harm.
CIGNA relied on the DOT to determine that the client was not disabled. The DOT is an overly generalized and largely outdated database that does not accurately describe occupations as they exist in today's labor market. The DOT was first published in 1938 with an emphasis on blue-collar jobs. It is no longer relevant to either information and services professions, yet CIGNA still relies on it.
CIGNA failed to take the treating doctors' opinions into consideration and instead relied on paid medical consultants who had never even met or spoken with our client.
CIGNA never had our client examined in person and instead relied on three flawed and biased reviews by unqualified, in-house medical personnel and the reports of two paid consultants who did a review of records only. These consultants were contracted through IntraCorp, to do an "independent" paper review. IntraCorp, at the time our client's review was done, was a sister company of CIGNA. In recent cases, CIGNA has been chastised by the courts for using Intracorp to perform peer reviews.
The Courts have said "that the point of having a third party medical provider is for it to make independent medical judgments. If, however, it is nothing more than a captured sister company of LINA, that information could be indicative of bias in the review process."
The paper reviewing doctors used in our client's claim denial have produced dozens of reports in favor of insurance companies. In fact, in more than 30 cases, these paper reviewing doctors determined that every claimant was not disabled. Ample proof of this was submitted with the appeal.
CIGNA's failure to conduct a proper vocational assessment, with its failure to perform a proper medical review regarding the specific duties of the client's occupation, provided undeniable evidence of CIGNA's arbitrary and capricious conduct and its failure to provide the client with a full and fair review of his claim.
Throughout the review process, CIGNA relied on selective portions of the medical records, blindly embraced the flawed findings of its unqualified in-house nurse consultants, and failed to evaluate the occupational requirements appropriately, all of which resulted in an erroneous and unfounded denial of his claim for benefits.
We submitted an appeal with unwavering support from the clients' treating physicians', a detailed job description and analysis as to why the client was disabled from his occupation. CIGNA reversed their decision and determined that the client was disabled from his occupation as a management consultant. He is now being paid.
Moral of the story - if your disability insurance company denies your claim, you can fight back, and you don't have to fight back alone.
Insights, Analysis, and Developments
Editorial Note: The implications of this case extend far beyond one individual's victory against CIGNA. It exposes systemic issues within the disability insurance industry, where profit motives can override genuine assessment of medical need. The repeated pattern of paper reviewers who never found a single claimant disabled in over 30 cases raises serious questions about the integrity of the "independent" review process. For anyone facing a disability claim denial, this case offers both a cautionary tale and a roadmap for success. The key takeaway remains clear: insurance companies count on claimants giving up after an initial denial, but persistence backed by thorough medical documentation and proper vocational analysis can tip the scales toward justice. The fight may be exhausting for someone already dealing with debilitating health conditions, but as this case proves, it's often a fight worth - Disabled World (DW).
Author Credentials: Ian is the founder and Editor-in-Chief of Disabled World, a leading resource for news and information on disability issues. With a global perspective shaped by years of travel and lived experience, Ian is a committed proponent of the Social Model of Disability-a transformative framework developed by disabled activists in the 1970s that emphasizes dismantling societal barriers rather than focusing solely on individual impairments. His work reflects a deep commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.