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Cigna Settles Denied Disabilities Claims

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Bangor, MECigna has agreed to settle wrongly denied disability claims with a variety of states. The states alleged three Cigna-operated companies improperly handled insurance claims. Improperly denied insurance claims can lead to bad faith insurance lawsuits against insurance companies.

Maine Insurance Superintended Eric Cioppa announced on May 22, 2013, that a settlement was reached with Life Insurance Company of North America, Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company regarding allegations that the companies did not properly assess disability insurance claims. According to a press release issued by Cioppa, the companies set aside $29 million for claims that are still open and $48 million in reserves in case benefits that were previously denied are overturned.

The companies have also agreed to change the claims handling process, provide a program so that the new claim procedures can be applied to wrongly denied claims and pay fines of more than $1.6 million. Other states involved in the settlement were California, Connecticut, Massachusetts and Pennsylvania.

According to documents from the Maine Bureau of Insurance, an investigation into the claim handling practices of the three companies began on September 15, 2009. Among concerns were that the companies’ claim handling practices did not conform with the Unfair Methods of Competition and Unfair and Deceptive Acts and Practices in the Business of Insurance Model Act (1972), and the unfair trade practices acts of Maine and Massachusetts.

Regulators said Cigna denied claims that should have qualified for payment of benefits, including new and ongoing claims.

“The state examinations showed that these three CIGNA companies were lax and not using available information to appropriately process disability income and insurance claims,” Pennsylvania Commissioner Michael Consedine said in a news release.

Unfairly denied insurance claims is a common complaint among those who take issue with insurance companies. Allegations have been made that claims are unreasonably delayed or denied through highly unethical means, including requiring duplicate paperwork being sent, claiming required paperwork was not received, or ignoring or contracting the medical opinion of the claimant’s medical professional.

When insurance companies have been found to practice bad faith insurance, claimants may be able to file a lawsuit or an appeal.

READ ABOUT DENIED DISABILITY INSURANCE LAWSUITS

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READER COMMENTS

Posted by

on
Cigna has denied me twice I need back surgery I'm scheduled for March sixth even my doctor call and talked to them they are still deniying me surgery please help

Posted by

on
Claudine: Make sure you pay your premium. They are hoping you will just throw your hands up - not pay the premium and drop you like a rock. It is the most important thing you can do. THEN - did they send you to this specific doctor for the WC issue? I know most companies usually have two doctors (by speciality) that you MUST go to. I also was sent to a doctor - who had been told by my employer what they thought happened and TOLD her I was NOT hurt. She didn't even touch me. She took one x-ray, declared I'm fine - probably bruised, to go back to work and rest on the weekend and I'd be fine. (I wasn't - I heard a POP in my shoulder or neck when I picked up a heavy object. Something is wrong. That doctor shouldn't have a license. I had to go to my regular ORTHO for surgery follow up (had back and neck surgery - the "children" at work put a object in front of my chair that I would be forced to pick up if I wanted to sit down. THey made it look like it was just a few pieces of paper in a recycle bin - but in reality they had put reams of paper in the bottom and a heavy metal object. SO POP. They wanted to say SEE - YOU are FINE. But no - I POPPED. The regular doctor said "You did SOMETHING, I'm not sure what. MY hardware POPPED in my neck and will have to be redone, but because he is also on the list of WC doctors, he said - I don't think this happened when you picked that up. (They get paid less if it is WC). Now he's saying we'll wait and see. What hes waiting for is for the time period to go past so I can't say its work related. As soon as the time is up - I have no doubt he will say I need surgery. In fact, the day that happened was the last day I was able to work. The hardware in my back was "floating" around due to a broken sacrum. He did surgery on that - and I have "Failed Back Syndrome" - in other words, I hurt more now than when he started - but my back is structurally stable. I have CIGNA LTD, they approved it a year ago, but right hwen it would have started the second year they send me a letter stating that they felt I could go back to work - they closed out the claim. Just like THAT. I said OH NO. THey didn't pay me for DEC, even though they didn't tell me until 12/27 - and I get paid on the 25th of the month. I wanted to know where my check was - instead I was told go back to work IF they will let you - but you are fine. NOT that my doctor said this - this was the disability insurance company. They are operating in BAD FAITH. I have filed an appeal, but my company said regardless of the appeal, I have until Mon to go back to work or they would consider that I have "resigned" - which leaves me without health insurance. I have gotten an extension with them, only because I said I was getting a lawyer and reporting CIGNA to the insurance commissioners office if they didn't straighten out this mess. THey told me yesterday to FORGET about the DEC payment - if my appeal wins, they will pay me then. They don't want me to have the money to pay the premiums so they can get off the hook. Supposedly they had a third party vendor helping me with SS Disability - but when I asked for copies of all documentations (in case CIGNA tells them to stop helping me - which they will after the appeal) - they said OH, we only have the forms you have filled out. I was shocked - where were my medical records? THey said the don't order them until we get to the judge portion of the application process. I was denied the first time, they are working on the second denial. Glad I didn't pay them - CIGNA did - but CIGNA is looking out for their best interest -making me think they are helping me - hoping to surprise me by denying my claim and hoping I'll be so desperate I'll go back to work - negating their claims. THen my company will fire me at 6 months for SOMETHING (they can always find something - hey - you were 3 min late today - you are undependable - fired. I know they can't decide if they want me back at work - afraid something will happen to make them really be on the hook. i'd like to tell them YOU ARE on the hook. I don't care about the WC, I qualify for LTD and that's all I want. WC - my doctor thought one of my surgeries was WC, his nurse told me - WELL, I think he can do it in 4 months, so I'll get in contact with you and just do your best at work. (I couldn't work - constant pain, the pain meds don't do enough AND they make me forgetful to the point I can't do my job on them. WHEN I told the nurse that the issue wasn't WC related - OH she said - I didn't realize. In that case, we need to RUSH the surgery - can you do it in 3 days? (Really, this happened. I said WHY if it was WC you all couldn't do it, but can now? SHe tried to say I misunderstood, but I had something with me and that wasn't working - so she said the doctor only has so many slots a year to do WC cases. (How can he and my company get by with this? He will say its not needed as badly if it is WC, and the company wants him to wait until the two years are up. HE did do the surgery in TWO days.

I think OUR LAWMAKERS MUST pass some laws to prevent employers and their WC surgeons from doing this to us. I couldn't believe the doctor said "SOMETHING" was wrong, but not sure what. Wait and SEE. I'm sure at two years, when company is off hook - it will be an emergency.

Our LAWMAKERS need to do further investigations of companies who are happy to take our premiums, but when it comes to a claim, THEY ALONE can decide if we qualify. THEY will always say NO. THey DENY regardless to see if they can wait you out. THat should be illegal. I asked CIGNA to send me to one of their doctors so I could prove I qualify for LTD. I have a disabling condition plus failed back surgery, need neck surgery, replaed ACL, knee replacement and a hip replacement. I'm in constant pain. I don't have a life - I can't do anything. But yet, they want to downplay my pain and act like you said - DEAL WITH IT and MOVE ON.

I'm glad CIGNA is under court ordered supervision, but they need to expand that to ALL states - have independent review of all cases they are trying to deny. I know there are people who scam, but I'm worse off than (my doctor said this) - than 99% of people currently on disability. But yet, they are trying to make me make a bad decision b/c I only have $100 left to my name. I had to spend one of my 401K's over the last five years to have four surgeries. I shouldn't have had to do that - but nobody else was going to give me any money - and you can't have that many surgeries without money - I needed to eat.

I make sure my premiums are paid - I ask my family to pay it if nothing else. I'm sure they will have to stop at some time - but I will find a way - if I have to start selling things. I'm disabled on a current LTD policy and they shouldn't be able to all of a sudden declare me cured when not even my doctor has said anything positive - I'm worse off than went the approved it. They ought to have to pay their customers a settlement when it is found that they denied a fair claim. That might stop them from denying cases that qualify. If it would cost them $100,000 if they deny and it is subsequently found by an independent doctor that they are wrong (they aren't exactly wrong - they are lying - they know I qualify). Keep the faith, and DO NOT just go back to work - that is what they want. (ANd companies DO set you up for failure so they can fire you and get them off their liability list. Our LAWMAKERS should do something about this to ensure they don't get away with this.

Posted by

on
I worked (on w.c) at Aarons Inc. I was injured during a shift on Valentines Day this year,A sofa that previously 3 of us had to deliver because of the weight and I injured my foot.. On This delivery way after hours only two of us delivered and I injured my back,I have Cigna and they sent me a letter stating I was out on family leave and not injured at work.they sent me a bill for my premiums which with what im getting on w.c would leave me and my 4 dependents 700.00 a month barely to live on.the fact is I am not on family leave I am out because of injuries.i called and left messages and no responses.I am still not able to work and the occ.health doctor told me on the last visit there's nothing I can do "learn to live with it"
I said well I need a M.R.I to see what's going on.
It was denied..this entire Cigna and Travelers makes you loose faith in the Company in which you work your butt off for doesn't offer any help.I will not "learn to live with it!" I want to be well and take care of and provide for my family!!!! I am frustrated and even worse this retaliation from this employer started with sexual harassment and they got worse from there..

Posted by

on
I was employed with Mobil Oil Corp. (ExxonMobil) for 34 yrs. I became ill with diabetes. resulting in the loss of portion of my right foot (all toes) in 2003 and finally the lost of my left leg. (BK) I filed for total disability with an attorney which was denied. However, to this date they continue to contact me regarding my disability. Please help me!

Eugene Booker

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