A former employee of the Visiting Nurse Association contacted our office after the Life Insurance Company of North America (aka CIGNA) sent her a letter in May of 2015 advising her that after a new review was conducted on her claim they now agreed that she was disabled and eligible for benefits for the limited time period of 09/04/2009 through 12/03/2009. As such, CIGNA told her it would pay benefits in the amount of $10,878.00 plus interest in the amount of $10,030.56 (a total of $20,908.56).
With this letter, a check was enclosed and the letter stated that by “cashing the enclosed check, you agree to accept this payment as full satisfaction of all claims you may have that, in whole or in part, arise out of or relate to (your disability insurance policy) during the Remediation Period and to forgo litigation and release Life Insurance Company of North America from any further liability regarding the denial or termination of benefits under the (policy) during the Remediation Period.”
After receiving the aforementioned letter, this disabled Nurse contacted Dell & Schaefer for information and advice as to this offer and the Regulatory Settlement Agreement. Prior to speaking with our law firm, this former Visiting Nurse Association employee was tempted to cash this check immediately as she was still disabled and any such funds would be an immediate blessing to her family. After speaking with Attorneys Gregory Dell and Alexander Palamara, the disabled Nurse was convinced that more could be done and more money could be a possibility.
Regulatory Settlement Agreement
In 2013, the Life Insurance Company of North America entered into a voluntary settlement agreement with participating state insurance regulators whereby it agreed to review certain previously denied or terminated claims made by residents of those states between January 1, 2008 through December 31, 2010. This period is known as the “Remediation Period.” CIGNA agreed that it would review claims it denied during that time period under enhanced claim procedures. Basically CIGNA agreed that it did a terrible job on some disability claims in the past and now agreed to give a new and proper review of those denied claims.
Dell & Schaefer Gets Involved
After being hired by the former employee of the Visiting Nurse Association, Attorney Alexander Palamara immediately investigated the claim. Attorney Palamara ordered a copy of the claim file from CIGNA. The claim file contains all the documentation CIGNA has obtained or created with regards to this Nurse’s claim. A quick review of the claim file showed not only that this Nurse should have been found disabled in 2009 when she first stopped working, but it also showed that CIGNA had enough information to justify continuing benefits through the present day. In fact, the Claim File contained a recent review by a doctor hired by Cigna. This independent doctor agreed that our now client remained unable to perform the material duties of her own occupation and any occupation. In his revaluation of April 24, 2015, Dr. Randal Wojciehoski found that our client would be completely functionally limited from 09/4/2009 forward. Furthermore, Dr. Wojciehoski stated that “(c)onsidering the complex comorbidities, it is my opinion to a reasonable degree of medical probability that (the claimant) remains completely and totally impaired from 09/04/2009 and beyond.”
Administrative Appeal Filed by Dell & Schaefer
Now armed with support not only from her medical records and her treating physicians, our client was also supported by CIGNA’s own medical reviewer. As such, an administrative appeal was filed outlining why CIGNA should determine that our client has been and continues to be disabled and how much money she should be paid above the $20,908.56 previously offered. Beyond supportive medical records, we offered financial proof that benefits should be paid from 09/04/2009 through the present.
The appeal was filed on August 21, 2015.
Cigna Agrees to Pay More Money
On October 14, 2015, we received a letter indicating the CIGNA now agreed with our assessment. At first CIGNA only agreed to pay through October 11, 2010 as it wanted to review updated medical information and get more information into her earnings from that time to the present. After being provided the requested information, CIGNA had no choice but to pay benefits through the present and agree to continue paying a monthly benefit until our client is no longer disabled.
Although it has been a tough and long fight that continues to this day, our client is happy that CIGNA finally agreed that she was disabled and is now paying her claim. Although one could question whether the initial offer of $20,908.56 was made in good faith and within the spirit of the Regulatory Settlement Agreement, our client’s receipt of over $450,000 shows that CIGNA is able and willing to correct a wrong it previously created.
Our client also knows that with the help of Attorney Palamara and Dell & Schaefer, she will continue to receive benefits as they will do whatever it takes to see that she remains on claim until she is able and ready to return to work.
If you have been offered money from CIGNA due to the Regulatory Settlement Agreement based on a past denied claim, although it may be tempting to immediately cash the check, please contact our office for a free consultation before you do so. First, the initial offer may only be a fraction of what is owed. Secondly, cashing the check may result in your losing your ability to challenge the amount paid and to get additional money. So please contact us as soon as such a letter is received. We will do whatever it takes to get you what you deserve.