Life Insurance Company of North American Disability Insurance DenialsLife Insurance Company of North America, a subsidiary of CIGNA, is one of the largest disability insurance companies in the United States. Attorney Evan T. Engler has helped a number of clients seek justice for their wrongfully denied disability insurance benefits by Life Insurance Company of North America or CIGNA. If your claim for disability insurance benefits has been denied by the Life Insurance Company of North America then you should contact attorney Evan T. Engler at (614) 610-9988. Evan T. Engler is an attorney and partner at the Columbus, Ohio based law firm of Harris & Engler and he helps clients with federal ERISA claims all over the Sixth Circuit states of Ohio, Michigan, Kentucky, and Tennessee.
File Only Reviews by Insurance Company PhysiciansBecause Life Insurance Company of North America is such a large disability insurance company, a number of ERISA lawsuits have been filed against them in federal district court. In Calhoun v. Life Ins. Co. of N. Am. (6th Cir. 2016), the disability insurance claimant was a senior maintenance technician who had chronic leg and back pain to the point to where he couldn't sit or stand for periods of over 20 minutes or so at a time. Life Insurance Company of North America ("LINA") initially approved the claim for disability insurance benefits, but then denied the disability insurance benefits after hiring a surveillance company which found the claimant grocery shopping and carrying grocery bags, among other reasons. The denial was appealed by the claimant and supported by medical records documenting the injury. LINA sent the whole medical file for review to different physicians for a "file only review," meaning that the physicians would only review the claimant's medical records and make an opinion on disability from those. The 6th Circuit found that file only reviews where the reviewing physicians raise concerns about the claimants credibility in claiming pain, without ever physically examining the claimant is a problem. In Calhoun, LINA's file only review physicians reviewed medical records and functional capacity evaluation results describing the claimant's disability and his limitations and then the physicians, without any real explanation, said that the claimant could work 40 hours per week. The 6th Circuit found the LINA's decision to deny the disability benefits was arbitrary and capricious because LINA had an opportunity to have their own physicians personally examine the claimant, but they did not do that, instead they just had the physicians review the claimant's file in making their decision to deny benefits.
This is similar to what happened in Guest-Marcotte v. Life Ins. Co. of N. Am. (6th Cir., 2018). There the claimant sufferent from a disease characterized by chronic pain and fatigue and LINA denied the claim without exercising their right to have the claimant physically examined by doctors. The court found that "the failure to conduct a physical examination, where the Plan document gave the plan administrator the right to do so, raises questions about the thoroughness and accuracy of the benefits determination." In Guest-Marcotte, LINA discounted the claimant's claims of disabling pain, essentially labeling them as "subjective." The file-only reviewing physicians hired by LINA found that there was no objective medical evidence supporting the limiting effect the pain had on the claimant's ability to work. The court found in favor of the claimant because it was undisputed that she had a hereditary disease known to cause chronic and severe pain, and she submitted a host of evidence indicating that she in fact suffered from such pain. LINA had the ability to physically examine the claimant, but instead took the word of file-only review physicians over the claimant's own doctors who actually saw her in person.
These kind of disability insurance claim denials happen all too often, but there is something you can do about it. You can hire an ERISA disability attorney to fight for your rights in getting your disability insurance benefits back. Attorney Evan T. Engler works with clients for ERISA cases in Ohio, Michigan, Kentucky, and Tennessee to seek justice against disability insurance companies who have wrongfully denied claims for disability insurance benefits. You can call Evan T. Engler today by calling (614) 610-9988.