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Cigna LTD and FCE
Dec 6, 2013

I receieved a letter from Cigna Insurance today saying that they were scheduling me for a Functional Capacity Evaluation to see if I was still disabled according to my employer LTD policy. I have been out on LTD for 17 months and under the care of a HIV specialist and a Nuerologist. I am going thru the SSDI process right now and waiting for a hearing. I am afraid that Cigna is trying to pay some Physical Therapist who does not know me or my symptoms to cut my benefits. If this happens I will have zero income. My question to you is....Why are they requesting this evaluation and is this normal practice? Do I have to go even though I have my own doctors?

Response from Mr. Chambers

Unfortunately, if you don't go to the FCE, they will be entitled to stop your benefits, claiming you are uncooperative. The contracts typically require you to permit to an examination by their doctors.

Chances are that your employer's LTD policy is like most others. The common practice is to define disability as the inability to perform the material and substantial duties of "your regular occupation." Then, after they have paid claims for two years, the definition usually changes from your regular occupation to "any occupation for which you are reasonably suited by education, training, or experience." Check your LTD handbook/plan document to make sure yours does that.

The change makes it easier for the carrier to find other occupations which they claim you can do under that second definition so many take the change in definition as an opportunity to try to dump claimants at that time, although they wouldn't describe it that way.

I suggest you go to the FCE. Take your doctor's name and address and ask them (or the insurance company) to send a copy of the FCE report to your doctor for review. Then he/she may want to respond to that.

If they won't do that, and they do stop your benefits, you have a legal right to get a complete copy of their entire claim file and you have 180 days to file an appeal. DO APPEAL any termination of benefits. With the claim file, you should be able to work with your doctor to dispute their conclusion you can still work.

If you want to find an attorney to help with an appeal, contact a local legal services agency or do a browser search for "attorneys - ERISA and your city." ERISA is the federal law this comes under.

Hopefully, the FCE will show that you remain disabled even if the definition has changed.

Good luck, Jacques



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