Cigna’s Market Settlement Causes Re-Evaluation of Many Denied Disability Claims

Cigna has agreed to a wide-ranging re-evaluation of its disability claim denials from 2008, 2009, and 2010 in California and from 2009 and 2010 in Connecticut, Maine, Massachusetts, and Pennsylvania.

The settlement affects certain long term disability claims in all of Cigna’s units – Life Insurance Company of North America, Connecticut General Life Insurance Company, and Cigna Health and Life Insurance Company.

After multiple complaints to the insurance commissioners in these states, regulators found that Cigna ignored Social Security decisions, discounted the findings of independent physicians, and didn’t consider workers’ compensation records when evaluating claims.  These practices forced Cigna to set aside $77 million for payments to current and past claimants who were improperly denied their disability benefits as well as to pay fines to the states.  In addition, the settlement requires Cigna to:

  • Establish a remediation program in which the companies’ enhanced claim procedures will be applied to certain previously denied or adversely terminated claims for residents of California, Connecticut, Maine, Massachusetts, or Pennsylvania.
  • Enhance claim procedures to improve the claims handling process to benefit current and future policyholders.
  • Participate in a 24 month monitoring program conducted by the insurance departments of each state, involving random sampling and on-going consultations.
  • Undergo a re-examination upon completion of the monitoring period.
  • Pay fines and administrative fees totaling $1.7 million.

“This regulatory action is intended to provide long-awaited relief for consumers who have a right to expect that their carrier will make good on contractual promises.  As regulators, we hold carriers accountable for adhering to laws and regulations of each state in which they conduct business.  This settlement resulted from market conduct exams and encompassed issues of serious concern.  It is a solid example of regulatory cooperation in protecting the policyholders of Connecticut and other jurisdictions.” said Connecticut Insurance Commissioner Thomas Leonardi.

For the official press release from the California Department of Insurance, click here.

For a copy of the Maine market conduct examination, click here.

The full regulatory settlement can be found here.

Although not quite the magnitude of UNUM’s market conduct settlement a few years ago, Cigna’s agreement can have a great impact on those claimants who were improperly denied their disability benefits.

If you think you may be eligible to have Cigna’s denial of your long term disability claim reviewed or have any questions about this settlement, please feel free to contact our offices toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.

 

Lyme Disease Diagnosis and Treatment: How These Issues Affect Your Disability Claim

With summer and the outdoor season upon us, there can be different causes of disability to deal with. One of the more common conditions we see during this time of year, especially in the Northeast, is Lyme disease. Although there is evidence that Lyme may be spread through multiple sources, the primary method of infection is a blacklegged or deer tick bite. Lyme is a complex multisystem inflammatory disease that can affect all of the major organ systems in your body and cause a wide range of symptoms including fever, headaches, rash, pain, vertigo, speech impairments, mood swings, depression, and hallucinations. In addition, these symptoms don’t always develop immediately. It can take days, weeks, or even years before the onset of symptoms due to Lyme disease, making it extremely difficult to pinpoint the causal event of the symptoms.  Continue reading

New Advances in Chronic Pain Treatment

If you are living with chronic pain, you know the stress and suffering that results. Chronic pain research continues and treatments still have a long way to go. However, researchers have made some significant gains in understanding and treating chronic pain in recent years, resulting in a new classes of drugs and treatments to help alleviate pain. Today, I am going to discuss some new therapies to explore how you may be able to reduce your pain and improve your life.   Continue reading

Another Success Story!

Every once in a while, we like to feature a story from one of our clients about their personal experiences with the disability claim process. Today’s story is an especially touching one. We spent a lot of time with working with Robert and his wife, and he ended up getting the disability benefits he deserved. The nature of his disability and the circumstances of his claim presented some unique hurdles that we had to work together to overcome, but we were able to provide the level of service he needed to satisfy the demands of his claims examiner and move on with his life. Here’s his story, in his own words:

My consultant, Fred Gosman, really helped with my disability claim! After I suffered a broken ankle, I found myself no longer able to work when the injury took a turn for the worse and turned into Reflex Sympathetic Dystrophy and Complex Regional Pain Syndrome. This is when I decided to file for disability benefits. Being an insurance agent, I thought I’d be able to easily complete the claim forms.  But after attempting it alone, I realized the enormity of my situation and decided to find help.  

I hired a claim consultant who promised lots of help, but instead she became abrasive and overbearing, angering my doctors and not helping my claim.  I had to quickly terminate that relationship and start over.  Once I found Royal Claims Advocates, my experience completely changed.  Fred helped me and my wife from the beginning, making sure I understood what was needed and helping gather all of the information.  He helped make sure my claim forms reflected my situation and worked with my doctors (They loved him!) to ensure they understood what was needed by Reassure America for my claim. 

He has helped make sure Reassure America was treating me fairly.  They asked for lots of records that didn’t apply to me or my claim, but he helped us correct their misunderstandings and provide the information they really needed. 

I’ve struggled through some rough parts of my disability, and Fred was flexible when I needed it.  Everything he’s done helped us move closer to filing my claim with support and documentation. His knowledge of disability insurance and claims helped my claim go smoothly.

Once we submitted my claim, my benefits were approved and paid within weeks, far quicker than I imagined.  Fred and his team at Royal Claims stayed with me to support and guide us through this challenging time.  Their help really has been invaluable to me and my wife.  As a former insurance agent, I appreciate the depth of their knowledge and the quality of their work.  It’s allowed me to focus on my recovery instead of fighting the insurance company for my benefits! 

– Robert S., Philadelphia, Pennsylvania 

Thank you Robert for your kind words!  Stories like these are the purpose we created our firm and the reason we fight so hard to ensure our clients get the disability benefits they deserve.

We’ve helped many others receive their benefits as well. If you or someone you know is in need of help on their disability claim, please contact us. You may call us toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.