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Cigna Long Term Disability Insurance Settlement Agreement Information


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Cigna / LINA Long Term Disability Insurance Settlement Agreement Information Video

As long term disability insurance lawyers that have helped thousands of disability insurance claimants we are pleased to announce that Cigna / Life Insurance Company of North America (LINA) has entered into a “Regulatory Settlement Agreement” ( hereinafter known as “Cigna Settlement”) with the Departments of Insurance from California, Connecticut, Maine, Massachusetts, and Pennsylvania. On May 8, 2013, five states and Cigna signed an Agreement which requires Cigna to implement new disability claim handling practices, re-evaluate long term disability claims that were denied during the time period of January 1, 2009 through December 31, 2010 and pay fines totaling $1,675,000. Residents of California are entitled to have a Cigna long term disability denial reconsidered if the claim was denied between January 1, 2008 through December 31, 2010. This specific agreement only requires Cigna to reevaluate claims for residents of California, Connecticut, Maine, Massachusetts, and Pennsylvania. It is likely that other states will continue to investigate Cigna and require them to enter into a similar agreement. If your Cigna short or long term disability claim has been wrongfully denied in any state, then Attorneys Dell & Schaefer is offering a immediate free consultation to advise you of your potential right to collect disability benefits.

$77 Million and More of Wrongfully Denied Long Term Disability Benefit Payments

According to the California Department of Insurance press release on May 24, 2013, “Cigna has set aside $77 million for projected payments to policy holders potentially nationwide whose claims were not handled properly.” If you have received a letter from Cigna advising of your rights to have your Cigna disability denial reconsidered, then you must respond to Cigna within 60 days of the date of the letter to preserve your right to a claim reassessment. We are recommending that all claimants that receive a Cigna reassessment letter contact Cigna immediately to advise of their desire to submit a reassessment of their prior claim denial. The next recommended step is to contact Attorneys Dell & Schaefer so that a claimant can be advised of their rights and give themselves the best chance to have their claim approved. If you have not received any letters from Cigna, our lawyers can help you to obtain the proper documentation. “Our long term disability attorneys have helped thousands of Cigna disability claimants and we know exactly what Cigna requires in order to approve a long term disability claim,” stated managing attorney Gregory Dell. Our website contains a lot of information about Cigna, such as videos, public comments, court opinion summaries and resolved cases which you can view by clicking here.

Highlights of the May 13, 2013 Cigna Regulatory Settlement Agreement

The complete Cigna Agreement is 33 pages and reads similar to your typical legally drafted document. You can click here to review a complete copy of the May 13, 2013 Cigna Regulatory Settlement Agreement. We also welcome you to watch our Cigna Settlement video in which disability attorneys Gregory Dell and Stephen Jessup discuss the Cigna Agreement in greater detail. The Cigna Agreement requires Cigna to implement a corrective plan of action, be subject to monthly monitoring by the five states department of insurance, and implement a reassessment program of previously denied claims.

The corrective plan of action requires Cigna to implement enhanced claim procedures for the handling of long term disability claims. The new claim handling procedures, which are specified in the Cigna Agreement discuss the following procedures which Cigna must comply with when making a determination on a long term disability claim:

In addition to the implementation of the new enhanced claim procedures and a claim reassessment program, Cigna will be subject to constant monitoring by the five state departments of Insurance for a two year period. The states will be monitoring claims denied after January 1, 2013 and claims that Cigna is required to reassess that were previously denied in 2008 through 2010. Cigna will be required to meet with insurance company investigators and provide monthly and quarterly reporting to the states regarding their compliance with new claim handling procedures and the status on the number of previously denied claims they have reassessed. Cigna is required to establish a Disability Claim Quality Assessment Team which is comprised of 10 Cigna employees with at least 8 years of disability claim experience. The Assessment team will be responsible for reviewing claims and making sure the new policies are being implemented properly. In addition, Cigna must form a Management Advisory Group, which will report to and meet on a quarterly basis with the department of insurance investigators. The Management Advisory Group includes the following Cigna high level employees: Vice President of Disability Operations, Group Claims Counsel, Director of Disability Claims, Total Quality Management, and Director of Policies and Procedures. At the conclusion of two years of monitoring by the states, Cigna will be subject to re-examination of their claim handling procedures. If Cigna fails to comply, then they will be subject to additional fines. Cigna was fined $600,000 by the California Department of Insurance in 2006 and then was fined again in 2013 due to their lack of compliance following a 2010 re-examination by the California Department of Insurance. Only time will tell if Cigna will be able to comply with the requirements of the 2013 Settlement Agreement.

Legal Help With A Cigna Disability Denial Claim Reassessment

The Cigna Regulatory Settlement Agreement requires immediate action by a previously denied claimant. It is important to take immediate action if your Cigna long term disability claim was denied. It is important to gather copies of any prior documentation regarding your previous Cigna disability denial. It is anticipated that Cigna will challenge the reassessments with high scrutiny; therefore claimants must be very prepared when submitting a reassessment. Contact any of our disability lawyers for a free immediate consultation to discuss your potential Cigna disability claim reassessment.

There are 17 opinions so far. Add your comment now.

Chet Hale:

Well, Cigna short term disability has now extended my coverage approval through the end of my 26 weeks on my employer’s short term disability policy. They forwarded my file to their long term disability department for review to start the long term disability that I purchased through my employer via payroll deductions for the past 11 years. Cigna called me Friday to tell me they were sending me the necessary forms to fill out & return.

I’ve known all along that if/when my social security disability gets approved that Cigna would reduce my payments by whatever amount that I start getting from social security (supposedly I will get at least $200.00 a month from Cigna). Now Cigna is telling me that however long it takes to get the social security approved, once it is approved I should get a lump sum back payment to the date I became disabled. Cigna says at that point I am required to pay them back whatever long term disability payments they have paid me. So much for Long Term Disability “Insurance” that I have been paying for, as it turns out it is more of a long term disability “Loan”. Kind of like paying for car insurance, having an accident, they pay off the car and when you buy a new one you have to finance enough to pay the insurance company back for what they just paid out on top of the cost of the new car?

If my initial social security claim is denied I will probably have to hire an attorney to help me re-file. According the Social Security regulations the attorney gets 20% (up to $2000.00) of my lump sum payment, if I then have to repay Cigna I could end up actually in the hole, owing more than I get in the lump sum.

Attorney Stephen Jessup:

Chet,

Unfortunately, ERISA group disability policies allow for offsets for SSDI benefits. Privately purchased policies from agents (individual policies) do not, but with the favorable language comes much higher premium rates. If you do have to hire an attorney to secure SSDI benefits, Cigna will not be entitled to collect from you any amount awarded to the attorney by the SSA. Cigna will only have a right to the net amount after the fees are reduced, and then only for the months that overlap with a period of time they issued benefits.

Ray Larsen:

On Feb. 2013 I was denied benefits by The Standard after 19 years. I sent in an appeal over 1000 pages long and seven months later got a short letter reversing their decision. Three quarters of the issues you raised with Cigna are exactly the same issues and techniques The Standard is using. I even asked for a copy of my policy and they conveniently left out a couple pages. My question: is it worth going to my commissioner even though I won my appeal? Regards.

Attorney Stephen Jessup:

Ray,

You can certainly file a complaint with your state insurance commissioner. As to whether the department will do anything is another matter.

Beth Cobb:

Mr. Jessup,

After reading this and the documents that go with it, I can definately tell you that Cigna is not complying with the guidelines that are stated in the douments.

In fact, I have been told twice by different people in different departments that they do not even take the award of SSDI into consideration because the SSDI guidelines are more lenient than Cigna’s.

And the SSDI award is not the only thing Cigna seems to ignore. But I will not go into those right now.

The statement that only time will tell if Cigna will be able to comply with the 2013 Settlement Agreement. Right now, I would have to say again that the anwer is a big NO!

Phil:

Why would any State’s insurance commission put up with this crap from any insurance company?

Michael:

Your link to the settlement does not show the other states that signed onto the terms of the settlement after the fact. Do you have a copy of that PDF?

Attorney Stephen Jessup:

Michael,

The states involved are California, Maine, Massachusetts, Pennsylvania and Connecticut.

Bertha Ortiz:

Can we travel abroad when in disability long term program? Can we live abroad? In Senegal there is an American psychiatrist.

Attorney Stephen Jessup:

Bertha,

Some policies have requirements that you reside within the United States or Canada in order to be eligible for benefits so you will need to review your policy as to same.

going broke:

I agree, I was on a (jpc) job at tmmi 80% temporary job but I am a full time employee. Been there now 12 years. Anyway, the job ended 1 year and 8 months, then was sent home again to start short term disability. It goes by fine 6 months then LTD kicks in deny. They want me to show that I can not do the job that I was doing. KICKER. That job ended, no longer there. It was a temporary job. That met my restrictions. I am still employed but not getting by employer or cigna.

Attorney Stephen Jessup:

Going Broke,

I am a bit confused as to the overall status of your situation. You indicate you are employed – is it with JPC? When was your disability benefit denied? Did you appeal the denial?

Mike:

I live in New York State. CIGNA is pulling the usual at least with my claim handling. I was first on STD (Short Term Disability) which transitioned to LTD (Long Term Disability). CIGNA has denied my claim a total of three times (one of which was verbal), stating insufficient documentation on file, I appealed all three denials which were then overturned. CIGNA is now pulling the not enough documentation again, even though I have been awarded SSDI. I also gave them, all the information/supports which I supplied to SSDI. CIGNA now states I need to go for an IME. I hope CIGNA is investigated, sued and fined in other states like New York State for their claim handling. I feel my claim was handled no differently then in the past. I wonder how many lobbyists are working for them?
*My conditions are primarily mental, but complicated by physical issues as well.. They are permanent/chronic and can only get worse not better.*

Attorney Stephen Jessup:

Mike,

Please contact our office before you go to the IME to discuss your claim and what policy provisions Cigna might employ to try to terminate your benefit.

Attorney Stephen Jessup:

Mike,

Please contact our office before you go to the IME to discuss your claim and what policy provisions Cigna might employ to try to terminate your benefit.

Renata:

Cigna denied me my std and then denied me my ltd…I was a cigna employee and they are refusing me any kind of help…I am now on ssi and cigna is a joke. They stated that my injury was pre-existing, really? I had surgery in 2012, for the same thing, how could a ruptured disk be pre-existing. I started with headaches, and then turned out to be disabled, cigna stated that they refused my ltd, but now are looking for me to repay my std.

Attorney Stephen Jessup:

Renata,

Please feel free to contact our office to discuss your rights under ERISA to pursue your benefits. We will need to see a copy of your denial letters as well as your short and long term disability policies.

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