I was injured in an accident and am right now unable to walk while I await reconstructive surgery on my back. I have a disability insurance policy through Cigna and I applied for benefits but they denied my claim for short-term disability benefits. What can I do about this Cigna disability denial? Can I sue Cigna for denying my disability? I have had the policy for years and I thought I was protected.
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Answer:
If you had a policy with CIGNA for disability and you have been injured, CIGNA is required to provide you with coverage if the injury falls within the type of injury covered in the policy terms and if you are disabled according to the terms of the policy. Your insurance policy should generally contain both definitions of what constitutes disability for insurance purposes, as well as a claims handling procedure. In addition, under the ERISA rules, the denial of benefits letter must clearly list reason why your benefits were denied; it must specify the policy provisions the company used to make the determination; it must describe any material or information you can provide to change the determination; and it must explain the process by which the claim was reviewed as well as what you need to do to appeal and time limits for appealing. If your claim was improperly denied, you may be able to appeal to CIGNA directly or you may be able to sue the company for an improper denial of your benefits. You should contact an attorney experienced in disability insurance and disability denials in order to determine what your best course of action is against Cigna.
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Posted by Christy Rakoczy on 23 Apr 2010