Recently, the California Department of Insurance settled with LINA, a daughter company of CIGNA – to the tune of $600,000. What was this penalty for? According to California Insurance Commissioner Steve Poizner, LINA was apparently ignoring certain claims that might have been valid disability claims.
Between January 1, 2005 and December 31, 2007 – LINA improperly handled insurance claims. It seems that not only did LINA deny many cases before ever receiving the medical proof those clients were entitled to their insurance payouts – but LINA ignored important information that may have reversed the denied claim on a number of accounts.
This means that individuals who had been paying their insurance premiums incase they were ever labeled ‘disabled’ and were unable to work and care for their families were now left with nothing to turn to. Even if their claims were 100% valid and legitimate, LINA may have simply turned a blind eye to their case. For this, LINA has paid the penalty and has agreed to reopen each of the cases reviewed between January 2005 and December 2007 to determine whether any of those cases should have been approved when they were denied.
LINA has a completely new set of standards they must use when reviewing these cases, however, policyholders have a right to be more than a little worried or upset. Because contracts are complicated, policyholders need to have the proper representation to help them receive the benefits they deserve. Often times, because contracts are so complicated, insurance companies have a multitude of chances to slow down the process or pause it completely.
Individuals who were denied by LINA or CIGNA between January 1, 2005 and December 31, 2007 (must have letter of denial with LINA or CIGNA logo on top) should seriously consider hiring an attorney to ensure that their best interests are being taken into account. Normal individuals are not trained in contracts and law, so most people will have a difficult time understanding the many facets and confusing twists of a contract. An attorney puts normal individuals on the same level with insurance companies who have studied contracts and laws so that a fair decision can be made.
According to long-term disability attorney Gregory Dell, “Disability Income policies are drafted with ambiguous and confusing contractual terms. This provides insurance companies with multiple reasons for delaying and denying disability income benefits.” This means that while normal people may have a difficult time understanding contracts, attorneys can easily explain the intricacies and help their clients and keep insurance companies on track to a payment of benefits.
By hiring an attorney, individuals can ensure that their best interests are being taken care of. The policyholders who are clients of CIGNA/LINA and will be facing reassessment should consider legal representation in order to ensure that they receive what is rightfully theirs. This could result in some clients being paid the benefits that they were originally denied, and in some cases, with interest. Using the new standards, LINA must evaluate each and every case that was denied between those two years, and the individuals who have an attorney are more likely to prevail.