Cigna Plan Administrator's Denial Of Claim For Disability Be
Sunday, Mar 08,2009, 11:42:27 PM Click:
February 23, 2009
CIGNA plan administrator's denial of claim for disability benefits not supported by record; Alfano v. CIGNA Life Ins. Co. of N.Y., No. 07-9661 (S.D.N.Y. Jan. 30, 2009)
The U.S. District Court for the Southern District of New York overturned an ERISA-regulated employee disability plan administrator's denial of a plan participant's claim for long-term disability (LTD) benefits in a suit brought by the participant for wrongful denial of claim. The record provided ample support for the conclusion that the participant was disabled under the plan.
Steven Alfano was a participant in an ERISA-regulated disability benefits plan issued to his employer college by CIGNA Life Insurance Co. of New York. On May 15, 1996, after being injured in a car accident, Alfano began receiving treatment from Dr. Michael Alexiades, an orthopedic surgeon. In June 1996, Alexiades concluded that Alfano's back pain left him unable to perform the duties of his job as a wage and salary manager.
Alfano applied for both Social Security disability benefits and LTD benefits under the plan. The Social Security Administration deemed Alfano totally disabled. CIGNA initially granted Alfano LTD benefits; but following a later review of his medical condition, CIGNA terminated Alfano's benefits. Alfano sued CIGNA for wrongful termination, and both parties moved for summary judgment. Conclusion participant disabled amply supported by record.
The district court found the record provided ample support for the conclusion that Alfano was disabled as defined in the plan. Alfano's treating physicians concurred in their conclusion that Alfano could not tolerate sitting for any duration longer than 10-15 minutes without a drastic change in position, and that this change in position often manifested itself in his lying down.
CIGNA failed to adequately support its conclusion that Alfano could perform sedentary work on a full-time basis, and ignored without justification portions of Alfano's medical records that documented his physical limitations, and the conclusions of Alfano's physicians that rather than improving, his condition was continuing to worsen. As a result, the district court reversed CIGNA's termination decision and ordered retroactive reinstatement of Alfano's LTD benefits.
Counsel for Alfano : Jeffrey Delott, 516-939-2999, Jericho, N.Y.
Counsel for CIGNA : Fred N. Knopf, Wilson Elser Moskowitz Edelman & Dicker L.L.P., 212-490-3000, New York; Emily A. Hayes, Wilson Elser Moskowitz Edelman & Dicker L.L.P., 914-323-7000, White Plains, N.Y.
Source: Insurance Law and Litigation Week, 02/23/2009
Copyright © 2009 by Strafford Publications, Inc. http://www.straffordpub.com/ All rights reserved. Storage, reproduction or transmission by any means is prohibited except pursuant to a valid license agreement.
February 24, 2009
Copyright © 2009 LexisNexis, a division of Reed Elsevier Inc. All Rights Reserved.
You may also be interested in:
Copyright: Unknown Source: PR Newswire U.S. Wordcount: Leader of Georgia
Insurers in China, which always show interest in IPO shares, did not subscribe
Copyright: The Associated Press. All rights reserved. May This material may not
Hardy Underwriting Bermuda Limited has entered into an agreement with Arab
When Reno County Sheriff's Detective Diana Skomal refers to her deer season,
CHICAGO--(BUSINESS WIRE)-- Fitch Ratings expects to assign an 'A' rating to the
Copyright 2009 GlobeNewswire, Inc.All Rights Reserved GlobeNewswire April 23,
- Most Read
- Most Discussed
- Most Emailed
- average monthly cost for health insurance
- Aetna CEO Ronald A. Williams' 2008 Pay Package: $3.14 Millio
- "Usual and Customary" Rates in the Health Insurance Industry
- House Democrats Say CBO Projects $500 Billion in Gross Savings From Medicare
- Getting Older, but working longer: the average age at retire
- UnitedHealth, Aetna Win TRICARE contracts, Replacement Humana, Health Net
- Tap Retirement Funds Penalty-Free Age Can Play A Role IRA
- Extension of TRICARE Health Insurance Coverage Included
- Health Plans awaiting verdict in 2010 Medicare Advantage Cut
- 10-Step HIPAA Compliance Program
- Obama Goes West To Promote Health Care Plans
- President Obama Calls Hails Progress on Health Insurance Reform Despite Defenders of the Status Quo
- New York State Health Plans to Deploy Enroll NY for Medicaid Leads
- Beware of Sharks annuity
- Obama Continues Health Care Push
- More Health Care For Less Cost; Pelosi's Promises Are Too Good To Be True
- Morgan Stanley to pay more than $ 7 million to resolve FINRA
- Indian Insurers Asked To Explore Daycare Hospital Treatment