We have encountered several cases where claimants have been denied their benefits not because of incomplete or inconclusive evidence of their medical conditions but solely because their conditions kept them from working longer than the guidelines used by disability insurance claim departments. When evaluating disability claims, claims examiners rely on industry developed resources to determine the expected duration of the claim, regardless of the specific circumstances. Based on these claim management practices that have been put into place by most insurance companies, we’d like to shed some light on the process used to assign expected return to work dates for claims and the extra steps that claimants need to take to protect their benefits if they’re disabled beyond these arbitrary dates. Continue reading
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.
The new year is always a good time to review the events of the past 12 months and see what you can do to improve your life over the next 12 months. If you’re dealing with health problems and a resulting disability insurance claim, this is also a great time to review the status of your claim and find ways to make the claim process stronger, simpler, and better. This can be done in whichever stage of the claims process you’re in. Whether you are still considering filing a claim, are waiting on a decision from the insurance company, are receiving benefits, or are facing a claim denial, it’s important to stay on top of your claim. Insurance companies are always looking for new strategies to increase profits and reduce claims, so you should always try and stay one step ahead of them. These 10 ways to protect your claim can help reduce your stress and work required on your disability claim over the next 12 months. Like most things, maintaining a strong disability claim is easier than rehabilitating a claim when it breaks (or is denied). Continue reading
Many claimants who contact our offices know little about disability insurance. Some are aware that they have disability insurance and need help, while others don’t even know what kind of policies they have and just happen to find our firm while trying to figure out their next steps. Most people realize the need for disability insurance but because it’s bundled in group packages from their employer, they have never seen their actual policy and know little of their coverage rules and limitations. When the time unexpectedly comes to file a claim for benefits, disability insurance companies capitalize on this lack of knowledge and use it to place some claimants at a significant disadvantage when initially filing their claim for benefits.
However, it doesn’t have to be this way. Information is available to learn about the risks you face of becoming disabled, different types of policies and options, and how you can protect yourself and your income. Doing this homework before purchasing a disability policy will help ensure that you have an understanding when you have to file a claim for benefits while you’re disabled along with the comfort that you and your family is protected if something prevents you from earning a living or continuing in your job. This ounce of preparation will allow you to use disability insurance for its intended purpose: to reduce the risks of everyday life. Continue reading
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
Taking advantage of the resources on the Internet is a great way to stay “in the know” and help understand what is happening in your disability claim. Whether you are an insured or an agent, the insurance companies try to use the claims process to their advantage by frequently tweaking policy interpretations and creating unnecessarily complex procedures and processes as hoops to jump through to obtain disability benefits.
Here are a few resources that are useful to help comprehend what you’re up against in the claim process and provide some information on different types of disability coverages:
- Insurance Consumers – Disability Insurance: This website is a great overview of disability insurance, from obtaining a policy, to filing a claim, to understanding the claim examination process. It’s a great starting point for understanding disability insurance.
- Social Security Disability Resource Center: While our firm does not normally handle Social Security claims, many of our clients are required by their insurance company to also file for Social Security disability benefits. This resource has proven useful for people to understand that separate process.
- “Trust Law as Regulatory Law: The UNUM/Provident Scandal and Judicial Review of Benefit Denials under ERISA,” by John H. Langbein, Professor, Yale Law School: If you have the time, this is a very interesting (but long) legal academic study on the UNUM controversy from a few years ago. A very informative and eye-opening article on bad faith practices in the insurance claims industry.
- LifeHealthPro – Disability: This is an up-to-date listing of current events and news articles about disability insurance, Social Security, and other aspects of the disability world. It is a good resource for current issues in the industry and to keep track of new developments.
- Insurance Forums: This forum is a great place for agents and consumers alike to ask questions and find information on a range of different disability insurance policies and companies.
These are just a few of the many resources available on the Internet to help you better understand disability insurance and the disability claim process. Knowing more will help you take ownership of your disability claim and give you a fighting chance with the insurance company claim department instead of going to them, blindly assuming that they’ll pay you fairly, accurately, and timely.
Realizing the underlying reasons for the actions of the insurance company along knowing and exercising your rights are vital to a successful disability insurance claim. If you would like to share any other good resources or want to comment on the sites provided here, please do so in the comments section!
As always, you may visit our website or call us at 855.828.4100 for more information on how our firm can help you!