Insurance Investigators: An Inside Look At Their Techniques

We’ve often mentioned insurance company investigators and their tactics as extremely adept at developing reasons to deny legitimate disability claims. Insurance companies like to hire former FBI agents and police detectives who have been specifically taught to treat their targets as adversaries and be cynical of any answers – which they innocently refer to as being professional. These investigators have undergone specialized training on how to dig up information and how to conduct interviews that can be twisted against claimants and used by claims examiners to deny disability claims. Due to our connections, our firm has seen some of the confidential training materials used by disability claims operations that help provide insight into the investigative techniques and methods used to interview claimants. This information can be invaluable to claimants, allowing them to more properly prepare for the interview, whether it’s a scheduled appointment or an unannounced visit. Today’s blog is going to breakdown and summarize some of the key points to help you handle an interview and understand the underlying purposes for the questions.   Continue reading

Social Media and Your Disability Claim, Revisited

We have talked previously in our blog about the dangers social media can pose for your disability claim. As summer kicks into gear and many people enjoy outdoor activities and vacation traveling, it’s important to revisit some of the social media points we’ve made in the past and provide some new insight into how different Internet sites may be able to help your claim and improve your odds of obtaining the disability benefits you deserve.   Continue reading

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.

 

March Madness: Our Elite Eight Blog Posts

What a difference a year makes! Where does the time go?

We’ve been writing articles for this blog for over a year, and we’ve learned as many things from our readers as we hope you’ve learned from us. As our topics have grown and more readers have found us, we wanted to make sure that some of our posts don’t get lost in the noise of the Internet and buried deep away where claimants would less likely be able to find help. In the spirit of the NCAA basketball tournament, we’re going to go through our most popular blog posts as well as highlight some posts that we think include topical, valuable information that may be helpful in your disability claim. Thanks again for reading our blog over the past year and making us one of the top-rated destinations for disability claim advice and help.  While we hope you never have any problems with your conditions or your claim, we’ll continue to be here to read, just in case, for years to come!

Continue reading

6 Potential Pitfalls of Your Chronic Back Pain Disability Claim

Almost everyone will experience some sort of back pain during the course of their lives.  This can extend from the cervical to thoracic to lumbar, not to mention shooting into arms and legs, and range in severity from a minor, short-term twinge to protracted, excruciating pains that last for months.  For people who deal with chronic back pain on a daily basis, performing what used to be simple tasks and normal work functions can become difficult and sometimes unbearable.  Even with surgical intervention, the pain may prove too overwhelming for many people.  In addition, this pain can lead to a host of other conditions such as depression and anxiety.  When this occurs, sufferers of chronic back pain may need to consider applying for their disability benefits.

The claim process is full of unexpected pitfalls and hurdles that may weaken the claim and cause benefits to either be delayed or denied, preventing you from having the money you were counting on to pay the many bills that crop up when you become disabled.  These following six tips represent some of the most common problems our clients have experienced when filing their claim for benefits based upon conditions that cause chronic back pain and the ways to avoid these problems, helping you receive your benefits as soon as possible when you need them most.   Continue reading

The Battle Between Insurance Companies and Mental Illnesses

Mental illness is on the forefront of much medical innovation and research today.  As we continue to better understand and comprehend the human mind and its illnesses, we’re able to more accurately diagnose and treat many different psychiatric conditions that were either misdiagnosed or simply ignored in the past.  Mental illnesses range greatly in length and severity of the conditions, but they can all be debilitating and render the patient unable to work in their or often, any chosen occupation.  If you or someone you know is suffering from a mental illness and has disability insurance through their employer or individually, you should be able to obtain disability benefits through your policy.  However for reasons I’ll discuss below,  insurance companies unfortunately tend to make this difficult and will vigorously try to delay, reduce, and deny your disability claim due to mental or nervous conditions.  Mental illness has a become a prime target for disability insurance companies, and those souls who are simply trying to collect their benefits have to be prepared for a fight. Continue reading

Around the Nation: News and Insight From Across the DI World

In the past few weeks, there have been some interesting news articles that either impact the landscape of the disability insurance industry or affect how disability benefits may be awarded in the future.  As a disability claim consultancy firm, we accept our challenging responsibility to stay current on industry news and realize that many don’t have the time or ability to keep up with the volume or focus of information.  There are developments in many different fields that can have a direct impact on disability insurance and individual claims, from new medical research to job programs to court decisions.  Taking the time to research our industry allows us to stay current on the best claims presentation and handling processes and updates the ways we interact with our clients and the recommendations we make about their disability claims.  We hope that seeing how we keep our clients up to date on news and developments helps your own decision-making process and builds trust in the disability claim community.  Of course, the only problem is that change and developments never stop.  While these topics were current when this blog post was written, everyday they become a little more outdated.  Please stay tuned for future news and updates.  Continue reading

The Truth About Disability Settlement Offers

In this blog, I often talk about the systematic approaches that many insurance companies use to delay or deny disability claims.  Lump-sum settlements and buy-outs, while not outright denials, are another tactic that insurance companies use to reduce their benefits payments and write-off high dollar claims or claims with problematic issues.  While we’re talking about settlements here, settlements can be defined as an offer and acceptance of a stated amount of money for giving up of all rights possessed by the insured under a policy contract to any future benefits along with the release of the insurance company from any liabilities from future disability claims.

Settlement offers can occur at any point in a claim but are usually brought up either after the company acknowledges liability or after a denial has been appealed, depending on when the offer is advantageous to the insurance company’s bottom line.  The amount of the settlement depends on the reserves booked by the insurance company for your claim.  Several factors, such as your age, health, discount rate, mortality and morbidity as well as any legal or compromising issues involved in the claim, go into determining the amount of the settlement the insurance company will offer.  These same factors will help you determine if the settlement is beneficial to you. Continue reading