Cigna New York Life Disability – At Dell & Schaefer, our network of experienced attorneys across the country has extensive experience handling life insurance/Cigna claims in New York, and we find that these claims tend to follow one of two paths. If the applicant has a detailed and comprehensive medical history that clearly documents that their disabling condition exists
If they initiate coverage under a New York Life/Cigna Disability Insurance policy, the claim may be approved. But in most other cases, where there may be some evidence that a medical condition existed before disability coverage began, or there are gaps or unanswered questions in the applicant’s medical records, Cigna can deny the claim. Learn about the most common reasons Cigna gives for denying disability claims, and how claimants can overcome them.
Cigna New York Life Disability
GREGORY DELL: Hi, I’m attorney Gregory Dell, I’m here with attorney Steven Jessup. And we’re going to talk about one of the most important aspects of any disability claim, which is applying for disability benefits. And this video will show about applying for long-term or short-term disability benefits with Cigna Disability Insurance Company.
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Now, Steve, also, this video is going to be about applying for benefits at New York Life, because it was announced just a few months ago that New York Life has acquired the disability portion of Cigna Insurance Company in a $6 billion plus acquisition. So we’re going to see more claims than Cigna has, and we think people at Cigna will continue to manage those claims because New York Life really doesn’t do a lot of group work at all. But right now we have no information to share about how it will change, if at all. But it can’t really change much about how we say someone should apply for benefits and what’s important.
We have now helped possibly thousands of Cigna claimants apply for long-term disability benefits. I want you to go through — we’re going to go through the steps of the essentials and the things that claimants need to know when they file a claim, but what’s the first — excuse me — the first thing you see when a Cigna claimant comes to you.
STEPHEN JESSUP: I mean, the first thing you have to look at is is it going to be an existing situation problem? Most of these policies, especially long-term disability policies – short-term often have no pre-existing conditions, and if they do – you usually only have to work for seven days. So it’s not a big deal.
The bigger concern is the long term. And like the standard language they have is that if you apply within 12 months of coverage under the policy, not necessarily employment, because you might have to wait three months before you’re eligible to be registered — 12 months of coverage. If you file for disability before then, that means Cigna will come back and they will usually look at the three month period before the disability. And if you have received treatment for a condition that you claim is a disability, then they will deny it because of a pre-existing condition.
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And a lot of times people say, you know, I’ve been working with them and I’ve been covered by the policy for about 14, 15 months. But it’s not because when you’re disabled, you don’t get that time. That’s when you work and shelter there.
So one of the first things we usually ask is how long have you been with the company, and then how long have you been on benefits – just to make sure they don’t have an easy way to deny. Because there is a way to overcome the existing situation if you can wait a little for the process. So that will always be number one for me.
GREGORY DELL: So did you have clients contact you during the previous period and were you able to help them get approved.
STEPHEN JESSUP: If they’ve received disability and they’re not coming back, or whatever the case may be. It will be very, very difficult. Now, in situations where people start as short-term requests and then they call us and we talk and they bring up the previous situation, sometimes they go back to work. So they can roll back into those 12 months of coverage and then look at filing again later. But if you fall within the parameters of that pre-existing condition, it’s very, very, very difficult to overcome it – unless you can say, there’s a new medical condition that’s not related in any way.
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And this, you know, is not an accurate diagnosis. Let’s say you know, the doctor thinks there’s something wrong with your back, for example. So that’s what they were working on, but it turned out to be something else entirely. If everything is connected and the diagnosis is then explained, Cigna will still see it in the context of the existing condition.
GREGORY DELL: All right. The second most important thing is medical information. How do claimants get to the point where you think they have the right medical records and why are medical records so important in applying for benefits with Cigna?
STEPHEN JESSUP: You know, starting with the first – why is it so important? Your claim may be based on medical information. If you haven’t been to the doctor, if the doctor doesn’t take good notes – you won’t get approved. It really is that simple.
So when we look at the medical records that lead to that, you want to see that there’s a conversation with the doctor, that there’s an issue, that you know, whatever your condition is that’s causing your disability, how it affects your ability to work and ask your doctor document it. Because Cigna will look at the record first.
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Surprisingly, we had a lot of people come in and file for benefits and file for disability before I even saw a doctor. That’s a problem because at the time of disability, they will always want to know what’s going on there at the same time. If there is no medical information to support why you were out that day, Cigna will definitely try to deny the case.
So your medical records, how they are documented, and your actual attendance at treatment are key. This becomes a problem in situations where you may need to see a specialist, especially for mental health. Sometimes it can take a while to get in touch with a psychiatrist or therapist, so you rely on your primary care doctor who may be able to help you until you see that specialist. But you can expect Cigna to also look at it and raise an eyebrow and wonder how bad it could be, you know, if you don’t treat with a specialist.
GREGORY DELL: What kind of information will Cigna ask for when claimants file their long-term disability claims?
STEPHEN JESSUP: They’re going to want to know all the doctors you’ve seen, so the name of any doctor. They will want to know about the job. They will get part of the employer, as you know, job description, compensation. But the important thing is why you’re applying – so what the medical condition is, and your doctor’s name and contact information is what they’ll start looking for.
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GREGORY DELL: Well, the claim form that Cigna requires – when you fill it out on behalf of a claimant, what are you doing that’s unique compared to what Cigna would normally ask from an unrepresented claimant and you don’t know any better?
STEPHEN JESSUP: In the claim form, you usually get one line to describe your medical condition, how it affects your ability to work. There is absolutely no way to convey that information, so we want to work with our customers to build attachments and plugins where we can expand on that, add additional information. If the claim form asks about a professional job you can’t do, well, same thing.
We will make another addition to it and it will list everything that happens with it. You want to present as much information as possible, because if you don’t have it, they will use it against you. The same thing when you look at your medical records. If something is not listed, they will assume it is not a problem or not a problem or not a concern. So we usually work with our clients to really refine what’s at the heart of it.
And also, in this request form there will be many things that are not