File Erisa Lawsuits On Time Cigna Won’t Have To Pay Court Says}

File ERISA Lawsuits on Time – CIGNA Won’t Have to Pay Court Says

by

Gregory Dell

The license chiropractor had brought a two-count complaint against CIGNA Disability Management Solutions, CIGNA Insurance Group and Connecticut General Insurance Company, and several other unnamed defendants. It was an exercise in futility.

The chiropractors claim arose out of a disability insurance policy purchased in January 1997. Later the same year he had to undergo several surgeries because he was injured in his back, left shoulder and right knee in an accident. According to the surgeon, he would no longer be able to work as a chiropractor. His application for long-term disability benefits was approved.As is common among disability insurance providers, a reevaluation of the chiropractor’s continued qualifications for receiving benefits was conducted in December of 2003. The information discovered resulted in the termination of his benefits in February 2004. A functional capacity evaluation (FCE) which had been conducted in December 2003 demonstrated that the chiropractor was no longer totally disabled and would be able to work in a different occupation. He appealed this decision in March 2004, but his appeal was denied. His benefits were permanently terminated in June 2004.Delay Occurs in Filing Claim against CIGNA.It wasn’t until five years later that the former chiropractor filed his claim against CIGNA in the Superior Court of New Jersey. Based on the statute of limitations, CIGNA responded by moving to have the chiropractor’s lawsuit dismissed.Before it could do so, the Court had to consider the chiropractor’s complaint in a manner as favorable as possible to him. The Court needed to guarantee that he was not wrongfully denied his right to equitable relief. In order to do this, the Court had to first weigh whether or not he was able to support his claim with evidence.What Statues Govern Claim against CIGNA?New Jersey has two chapters under which insurance policies. CIGNA argued that the New Jersey statutes under chapter 27 governing group life, group health and blanket insurance policies applied. The disability attorney argued that the New Jersey statutes under chapter 26 governing individual insurance policies applied. Who was right?The Court found that CIGNA was correct in this case, because the chiropractor’s policy was issued as part of a group policy issued to medical professionals who had banded together so they could obtain a better rate. Under chapter 27, a disability lawsuit could not be filed more than three years after disability began.Disability Attorney’s Arguments for Voiding Statue of Limitation are Unconvincing.The Court was not swayed by the disability attorney’s argument that statutes of limitations only apply to those who are filing initial claims. It rejected his argument that the law did not require his client to file a lawsuit within a limited time, because his client was only furnishing “proof of continued total disability,” not “proof of loss.”The Court didn’t find any language in Chapter 27 that drew this artificial distinction. Rather Chapter 27 defined “proof of loss” as written proof of loss whether that proof supported an initial claim or continuing proof of disability. The law also recognized that disability insurance plans had the right to request continuing proof of loss at reasonable intervals.The Court also recognized that the insurance policy itself contained a three-year statute of limitations. The terms of the policy made it clear that anyone receiving disability benefits had 30 days within which to provide written proof of continued total disability when a request for such information had been made. The wording also linked proof of loss with the provision of written proof.Court Finds in CIGNA’s Favor.Having considered whether the former chiropractor had a right to remedies, the Court applied the three-year statute of limitations upheld by both New Jersey insurance law under chapter 27, and the CIGNA disability benefit plan. If the chiropractor wanted to contest the termination of his benefits, he would have had to file his lawsuit by January 17, 2007, three years after he’d lost his benefits. Because there was no evidence in the record that suggested that CIGNA had delayed its claims process, the Court could not find CIGNA at fault for the chiropractor’s failure to file suit before May 26, 2009. Rather he had waited over two years past the deadline set by the statute of limitations.This case highlights the importance of filing a disability insurance claim promptly after a final denial of benefits has been issued. The New Jersey statute of limitations was actually shorter than the one provided for in CIGNA’s policy. Don’t let the fear of how much it will cost delay a prompt filing of an ERISA disability benefit denial claim. Find a qualified disability attorney who is willing to work on a contingency basis. This man lost his rights. You don’t have to.

Gregory Dell is a

florida disability attorney

and managing partner of the

disability law firm

Attorneys Dell & Schaefer. Mr. Dell and his team of disability attorneys have assisted thousands of long-term disability claimants with their claims against disability insurance companies. Visit diAttorney.com for a free consultation.

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File ERISA Lawsuits on Time – CIGNA Won’t Have to Pay Court Says}