Question

Cigna only sens me a monthly check for the amount offset and refuses to apply my full monthly benefit amount to my claim. How do I fix this? Also, how do I obtain a copy of my policy?

Asked on April 17th 2014 by Joe
I’ve been on Cigna LTD since last June. Initially, Cigna only approved my claim for a knee and foot problem. I had also been suffering from anxiety and depression, which I admitted to them that the anxiety was a pre-existing condition, but not the depression. Needless to say, Cigna tried to claim my depression was also a pre-existing condition. After several months, numerous letters and medical records sent to Cigna regarding my depression, they did a “peer medical review” and determined that my depression was not pre-existing. While waiting to have knee surgery I rolled and fractured my ankle on my other leg. This has been an issue for 8 months now and my fracture has still not healed. With all that being said, I had been receiving CA SDI benefits up until March of this year. Of course Cigna offset my benefit amount due to “other income”. No problem so far until I notified Cigna that my SDI benefits were exhausted last month. The issue I am having now is that Cigna is only sending me a monthly check for the offset amount and refuses to apply my full monthly benefit amount to my claim. What options do I have at this point to rectify the issue? I have also requested a copy of my policy numerous times and they refuse to send it to me.

Answer

Answered on April 18th 2017 by Attorney Stephen Jessup

Joe, Have you provided them with any written information from the state documenting your CA SDI benefits have ended? With respect to obtaining a copy of your policy, it is your former employer’s duty to provide you with a copy of your policy, and not Cigna. I would suggest you contact your HR department to secure a copy.