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Cigna Plan Administrator's Denial Of Claim For Disability Be

 

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Copyright 2009 Strafford Publications, Inc.All Rights Reserved Insurance Law & Litigation Week

February 23, 2009

Pg. 33

438 words


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

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February 24, 2009

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