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Cancellation of LTD Coverage
Sep 3, 2004

I have several questions regarding LTD coverage. I have been on LTD since 2003 after a series of HIV related infections and hospitalizations. My LTD income is my major source of income. I also receive SSD. My LTD provider (CIGNA) recently denied my continued coverage. (In fact, they dropped me in May of this year, but didn't bother to notify me until July.) I have been appealing their decision through the proper channels, and working with my doctors to provide the necessary lab information CIGNA is requesting. My doctor does NOT want me to return to work at this time even though I am clinically doing better than I was when I went out on disability. CIGNA cites my "gain in weight" as an indication of my improved health status. (Of course I've gained weight, I'm on steroids.) My question is who actually gets to decide if my HIV/AIDS is severe enough for me to continue on LTD? CIGNA or my doctor? My LTD policy provides for coverage through age 65 if you are "totally disabled." CIGNA doesn't seem to feel that AIDS is "totally disabled." I would like to return to work at some time, but my doctors aren't ready for me to return now. My doctors have written letters to CIGNA to this effect. I'm in the third stage of the appeal process. Given my doctors' advice, should I "push this to the wall" and sue CIGNA if they continue to deny my LTD? I can't go back to work at my previous employer without a "release form" from my doctor. I've been without this LTD income for over 3 months now, while CIGNA's administrative process drags on. Are there any repercussions if I were to sue CIGNA under ERISA or EEOC guidelines? Thanks for all that you do here. It's greatly appreciated!

Response from Ms. Franzoi

I am sorry to hear that you are having this difficulty. I would recommend that you see an attorney for some advice. An LTD plan requires continued proof of total disability in order for benefits to remain in pay stauts. It sounds like CIGNA and your docotrs are disagreeing on whether or not you are totally disabled. It is typical in situations like this for the insurer to request that you see another physician to verify your disability. Has this happened? If so, what did this physician recommend? Another option might be residual disability, if your CIGNA LTD plan has that clause. This would allow you return to work on a part-time basis while still drawing disability benefits. If your doctor feels this would be appropriate and your plan has this language, you could consider this.



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