Question

Is it capricious if another person's medical information was included in my file and likely used in the determination denial? Would Cigna be liable for other other damages or does ERISA insulate them?

Asked on September 1st 2014 by Stev
What if, upon receipt of your claim file (after denial), you find another person’s medical records and job descriptions were included in your file and likely used in part in the determination denial? Would this be arbitrary and capricious? Would the carrier be liable for any other damages or does ERISA insulate them?

Answer

Answered on September 2nd 2014 by Attorney Cesar Gavidia

Stev, If Cigna’s denial is based on records and information that do not belong to you then their reliance on same to deny a claim could be deemed arbitrary and capricious. Unfortunately, ERISA does not provide for additional damages against Cigna. Please feel free to contact our office to discuss how we may be able to assist you in appealing the denial of your benefits.