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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 116711
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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I fell coming out of a store 2 month ago and fractured my left

Resolved Question:

I fell coming out of a store 2 month ago and fractured my left foot. The doctor said I had broken my toe and that I missed surgery and screws by a hair. I was in much pain and was told to stay off the foot for 6-8 weeks. I went on disability, but the company that my employer uses to match my salary to 100% which is Cigna, denied me my claim when my Dr. extended my time off for two more weeks due to pain and suffering.
What can I do about Cigna denying my claim? and can they get away with it? I've worked for 36 years and this is the first time I have needed to use disability.

JB
Submitted: 6 years ago.
Category: Legal
Expert:  Law Educator, Esq. replied 6 years ago.
You first need to read your policy to make sure you did not reach any maximum amount of compensation set by the policy for the injury. Then, assuming you did not reach any maximum amounts, you would have to appeal the denial and you would need to use your medical documentation regarding your inability to work and these cases hinge on the strength of the medical evidence. Thus, this is all going to be on the strength of the report your doctor writes and when submitting the new report with your appeal letter you explain that your doctor has stated your injury required the additional 2 weeks and their denial based on the medical evidence is in bad faith and that if they refuse to approve the additional time you will consider further legal action. If they refuse, then I am afraid you are going to have to file suit against them for breach of contract.


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