Holding Insurance Companies Accountable for Disability Policies

Did a CIGNA Group insurer deny you disability insurance between 2008 and 2010? Some say this may entitle you to a re-evaluation of your claim as part of the $77 million recent settlement by CIGNA to cover claims that the nationwide disability insurer inappropriately handled.

At DarrasLaw, we are familiar with the tactics and tendencies of large disability insurance companies. We have helped thousands of clients stand up to insurance giants CIGNA and LINA to overturn denials of valid claims. We are nationally recognized as the top disability law firm in the United States. We regularly handle bad faith individual claim disputes and group appeals involving disability insurance. Our experienced disability insurance lawyers and ERISA attorneys are committed to helping people when their insurance companies wrongful delay or deny their claims. If you believe your disability insurance carrier wrongfully delayed or denied your claim, or if you are getting the classic run-around, we can help you pursue your rightful benefits.

If you purchased disability insurance through CIGNA—or its affiliate Life Insurance Company of North America (LINA)—but encountered problems when you tried to collect on a legitimate claim, you are certainly not alone. All insurance companies deny claims, but regulators have cited CIGNA and LINA for improperly denying claims and ignoring proof of disability.

If your disability claim under a CIGNA or LINA policy was delayed, denied, or devalued, contact us for a free consultation. We handle individual bad faith disability claims and long-term disability ERISA appeals nationwide.

The $77 Million Settlement

Investigations—which were coordinated by Maine and other states arguably revealed that three Cigna subsidiaries (CIGNA) had allegedly improperly handled claims. CIGNA failed to use the information available to it when it processed disability income insurance claims. This led to unfair or wrongful delays and denials. Pennsylvania Insurance Department Commissioner Michael Consedine stated on record that, “The state examinations showed that these three Cigna companies were lax and not using available information to appropriately process disability income insurance claims.” Essentially, the investigation found that CIGNA’s claims-handling practices needed improvement.

California, Connecticut, Maine, Massachusetts, and Pennsylvania took action against CIGNA and reached an agreement on May 13, 2013. Per this agreement CIGNA is required to re-evaluate claims that were affected by its mishandling of claims. The remediation period covers claims denied in California from January 2008 through December 2010, and in the other four states from January 2009 through December 2010. CIGNA must also set aside $77 million to pay back people whose claims it wrongfully denied during this period.

According to Law360, the action was prompted by 2009 investigations that determined the Cigna companies’ violated federal and state insurance trade practices laws. Per the ultimate agreement, the participating states will monitor the companies’ compliance with the settlement terms for two years by randomly selecting denied disability insurance claims. According to the settlement terms, among other things, CIGNA had to pay each of the five states a $150,000 fee for costs incurred in the monitoring programs, along with additional fines to several of the states’ insurance departments.

A basic overview of the terms of the CIGNA’s settlement agreement, as outlined by Maine’s insurance superintendent Eric Cioppa, is found below. CIGNA must:

• Enhance their claim procedures to improve the claims handling process to benefit current and future policyholders.
• Establish a remediation program in which the companies’ enhanced claim procedures will apply to certain previously denied or adversely terminated claims
• Participate in a 24-month monitoring program conducted by the insurance departments of the five states involving random sampling and on-going consultation.
• Undergo a re-examination upon completion of the monitoring period.
• Pay fines and administrative fees totaling $1,675,000.

For more information about this settlement offer, click here.

If you think you are entitled to a part of the money that CIGNA set aside in this agreement, contact us today. Our team of experienced bad faith disability insurance lawyers and ERISA attorneys at DarrasLaw have the knowledge to look into your claims and determine whether you can recover compensation under this settlement. Don’t miss out on money to which your denial may entitle you. It is free to call or contact DarrasLaw online.

Other Major Litigation Against LINA (CIGNA)

Through its affiliate company LINA (Life Insurance Company of North America); CIGNA is one of the largest underwriters of long-term disability insurance plans in the United States. In 2016 alone, CIGNA reported a net income of $1.867 billion. LINA recently settled with the California Department of Insurance in relation to an investigation of disability claim denials in calendar years 2005, 2006 and 2007.

The lawsuit alleged that LINA systematically denied certain types of long-term disability claims, often without reviewing claimants’ medical proof. Furthermore, the suit alleged that LINA ignored information that could have reversed the adverse decisions. In the California settlement, LINA paid a penalty of $600,000 and agreed to reopen all of the claims that it might have wrongfully denied.
The California Department of Insurance examined Lina’s claims handling practice and procedures—in California—for the period starting in February 2005 and ending in June 2006. Generally, the examination aimed to determine whether the operating procedures of LINA conformed to its own contractual obligation in its policy forms—as well as to relevant California state laws.

Among other things, the examination reviewed:

• LINA guidelines, procedures, training plans and forms, etc.
• Application of these guidelines, procedures, and forms in claim files and related records
• Consumer complaints received by the department.

Before the investigation was completed, LINA and the California Department of Insurance entered a stipulation and waiver. While LINA officially denied wrongdoing, some question whether LINA would otherwise voluntarily agree to this stipulation—but for the exposure of what further investigation could have uncovered. The following offers more insights into the conditions of the stipulation:

• LINA agreed to stop engaging in any acts or practices in the business of life and disability insurance that violated California codes and laws.
• LINA invested roughly $2 million to establish a California-based claims administration office for the purpose of enhancing the quality of the administration of claims of the state’s consumers.
• LINA has invested money to lower claim caseloads in California.
• LINA increased spending for investigations and specialty claims-related resources.
• LINA has established a unit called a “National Consumer Advocacy Team” designed to ensure timely and effective responses to consumer inquiries and complaints. It also increased staffing for its appeals team.

LINA formally admitted no wrongdoing, so you are left to decide whether the terms of the stipulation and waiver result from prior improprieties. Many of the violations cited in the 2006 report against LINA—that the California Department of Insurance provided before LINA’s voluntary agreement to this stipulation and waiver—are directly remedied by its modifications.

In addition, the stipulation affects open claims and future claims—from the date of the stipulation and waiver. Moving forward, LINA agreed to:

• Review, clarify, and update, as necessary, its policies and procedures related to initial claim evaluations, ensuring that claimants are given a reasonable timeframe, including any extensions permitted under California or federal law, to submit information in support of their claims
• Expand its methods for requesting medical documentation at LINA’s expense from claimants’ treatment providers, including processing pre-payment requests, following up on outstanding record requests, and using copy service providers where necessary
• Partner with medical providers, as appropriate, to address and resolve providers’ requirements for customized authorizations or other forms relating to the release of claimant medical information
• Make reasonable efforts to identify and obtain all records relevant to its claims evaluation and termination including workers’ compensation, Social Security Disability Income, and other administrative records
• Reinforce its existing policies and procedures, or create new policies and procedures as necessary, related to the following:
  • Use of Functional Capacity Exams (FCEs) in the claims review process
  • Review of the claim file as a whole in making determinations
  • “Own occupation” evaluations
  • “Any occupation” evaluations and consideration of a claimant’s “station in life”
  • Impact of the “course and nature” of a claimant’s condition on a claim
  • Conduct new or refresher trainings related to certain awareness and new review policies
• Find this information and more in LINA’s Stipulation and Waiver, dated 08/2009

In addition to these proactive actions, LINA had to also remediate—where applicable. In other words, per the stipulation, LINA must review denied claims—from 2005 through 2007—to determine if the new standards would have changed whether those claimants received benefits. For those claims where the answer is “yes,” LINA must take appropriate remedial action, including payment of any such benefits due—including interest where applicable. If it is unclear whether a particular claimant should receive payment under the new standards, LINA must refer the claim to a team for additional investigation.

The California Department of Insurance scheduled to follow up, and LINA was required to timely and substantially comply with the terms and conditions of the stipulation and waiver. LINA must also maintain documents—electronically or by hard copy—that evidence the application of its new standards both proactively and retroactively.

Though much of these stipulations and provisions are only mandated for LINA’s (CIGNA’s) California residents, the proactive components may have broader implementation—as to avoid further corrective actions. If you are a California resident, and you feel that you are entitled to a re-evaluation of a previous denial, contact us today. Our team of seasoned disability insurance denial lawyers and ERISA attorneys at DarrasLaw have tremendous experience fighting—and beating—the billion dollar companies, like CIGNA, on behalf of aggrieved consumers who were wrongfully denied. If you are entitled to a reevaluation under LINA’s new standards, we can help! Please call or contact us DarrasLaw online.

How Do I Know if My Disability Benefit Delay or Denial Is Wrongful?

Usually, there is no smoking gun; there is no grand act by the disability insurance company that will prove, that your delay or denial of disability insurance benefits is wrongful or in bad faith. Still, certain actions—when requested or performed by insurers—are signals that you may need to consult an experienced disability insurance bad faith denial lawyer. CIGNA/LINA, as well as most other big insurance companies, are known to employ tactics to delay, deny, devalue, and terminate valid disability coverage claims. These can include:

• Presenting exhaustive requests for occupational, financial or medical records while delaying the receipt of timely disability benefits
• Requiring an unreasonably lengthy in-home field interview or claims review by a CIGNA/LINA investigator before payment
• Requesting an Independent Medical Exam (IME) by an unqualified doctor or a paper review by a doctor chosen by the CIGNA/LINA with poor credentials or marginal training
• Questioning your doctor independently, without notifying you, via a mailed questionnaire or by phone in an effort to secure an admission that you are capable of some form of work

These are just some of the many bad faith tactics that insurance companies are known to employ to delay or deny legitimate disability benefits. The top disability insurance attorneys and ERISA lawyers at DarrasLaw review new disability denials daily to stay on top of all the new ways insurers attempt to line their pockets by collecting premiums but denying coverage. We can help you understand what’s happening if you have questions or doubts about your claim.

Experienced Disability Insurance Attorneys for CIGNA/LINA Disability Claims

Not every CIGNA or LINA denial is grounds for a lawsuit. Understanding what your policy categorically excludes is just as important than knowing what it covers. Your awareness of your policy’s exclusions and limitations can help you pick disability plans that work for you and avoid companies that will not cover you when you need them most.

If your legitimate, disability claim was denied, the bad faith insurance disability lawyers and ERISA attorneys at DarrasLaw can review your case and help you pursue your legal remedies.

At DarrasLaw we know all the bad faith tactics used by insurers and specific ways in which CIGNA/LINA has deprived policyholders of the benefits they deserve. We can address delays and denials, disputes or questions arising from:

• Interpretation of CIGNA or LINA policy provisions and exclusions
• Definition of “own occupation” and “any occupation” in CIGNA and LINA policies
• Independent Medical Exams (IME) by CIGNA or LINA
• Functional Capacity Evaluations (FCE) by CIGNA or LINA
• Attending physician statements requested by CIGNA or LINA
• CIGNA or LINA field interviews by adjusters/examiners
• Private investigators and surveillance by CIGNA or LINA
• Proof of employment and employment file requests by CIGNA or LINA
• Return-to-work attempts used against the insured
• Mental/nervous limitations in CIGNA or LINA policies
• CIGNA or LINA medical consulting reviewers specialty
• Late or missed premiums
• Termination of benefits by CIGNA or LINA
• Not returning policyholders’ calls or emails
• Claim sent materials were lost, destroyed or never allegedly received
• Repeated requests for duplicative “additional information” from CIGNA or LINA

How Our Disability Insurance Lawyers and ERISA Attorneys Can Help

Consultations are free. If you have questions about your policy—or need assistance with a claim that you have submitted or will submit—please contact DarrasLaw. The following are just a few of the things that we can do to assist you, where possible, in getting the outcome you desire:

• Determine whether your policy covers you only if you cannot work at all in your occupation or whether you meet the social security definition of disabled
• Make sure your occupational description and vocational information is accurate
• Ensure that all medical evidence is evaluated properly
• Identify violations of your rights under the Employee Retirement Income Security Act (ERISA) if your policy is group coverage
• Ensure that any company required doctor examinations are with physicians in the correct medical specialty
• Help you prepare your initial claim forms and proof of loss documents
• Make sure that your doctor’s notes fully describe your disability and show why you cannot work physically and mentally
• Fight for full payment of all your benefits with an appeal or a lawsuit

Don’t Throw It Away—Keep All Documentation!

If CIGNA/LINA delays or denies your claim, please keep (or retrieve) copies of all correspondence between you and them whenever possible. If you cannot find all of the documents that you think are relevant, do not despair. Find what you can, make note of the documents you remember submitting but can’t locate, and save everything moving forward.

How Do I Afford a Top-Rated Bad Faith Disability Insurance Lawyer or ERISA Attorney?

At DarrasLaw, we take all of the disability insurance claim denial cases that we choose to represent on a contingent fee basis. This means that you do not pay us up front. We do not collect fees, unless we get results.

We cover all up-front costs associated with your case—including medical evaluations and investigations. We hope to help as many disabled people from all across America as we can. This contingent fee arrangement helps us ensure more people who need an experienced disability insurance lawyer, or ERISA attorney, can get one.

DarrasLaw Has Recovered Nearly $1 Billion in Wrongfully Denied Insurance Benefits

We fear no insurance company, including major insurers like CIGNA/LINA. We know how they handle claims, and we know what to do to aggressively assert your rights to hold them accountable.

Trial lawyer Frank N. Darras and his team handle a wide spectrum of long-term and short-term disability insurance claim denials, from a few thousand dollars to claims worth millions. We have an unmatched litigation track record of forcing insurers like CIGNA/LINA to fulfill their contractual obligations.

Testimonial

Review: 5/5 – ★ ★ ★ ★ ★

“Heather, We are finally getting settled in New York, on Long Island. I want to thank you for all your dedication and hard work you and your staff did on our behalf to settle this case against CIGNA. Also I recall all the firms I called or emailed for over a month, with no firm but yours willing to take my case. I remember the excitement I felt when all the hard work I did finally, would be represented. You made my day! I especially want to thank you for foregoing the fees you incurred and generously absorbing these charges on my behalf. It will help! We greatly appreciate, and will be using that money for ourselves, not for expenses. Once again thank you for improving our lives”

– Tommy & Pat R.

DarrasLaw is the leading disability law firm in the nation. We are fully committed to our mission: to serve the disadvantaged and disabled by ensuring our clients receive what their insurance companies rightfully owe them. Our compassionate, seasoned disability insurance lawyers and ERISA attorneys have the skill and experience to take on large insurers at the negotiating table and, if necessary, in the courtroom.

Our top-rated, national disability insurance lawyers and ERISA attorneys are experienced with CIGNA insurance claim denials, and we take cases throughout the United States. Call us at 800-898-7299. We offer free consultations on all matters, including free policy analysis and claim help.