Insurance companies employ a variety of claim handling techniques when seeking to wrongfully terminate a claimant from continued benefits. Fortunately, some courts are beginning to see through such conduct.
CIGNA has once again seen its claim handling of long term disability claims chastised by a Federal Court. The decision, Alfano v. CIGNA Life Insurance, from the Southern District of New York, determined that CIGNA’s conduct was arbitrary and capricious. In terminating a claim which had been paid for several years, CIGNA relied upon the results of a flawed Functional Capacity Evaluation (“FCE”), as well as paper reviews of the medical records, by biased in house and outside medical reviewers. The Court decided that the medical reviews relied heavily, if not exclusively, upon the FCE’s summary conclusions that Alfano was capable of performing sedentary work, despite the fact that the underlying testing data was inconsistent with that conclusion.
The claimant suffered from back pain and leg weakness as a result of a motor vehicle accident. His claim was approved by the Social Security Administration, and CIGNA embraced the financial benefit of the SSDI decision to reduce its obligations to Mr. Alfano. The Court found such conduct to be some indicia that CIGNA was not acting properly. The Court noted that while the SSDI determination was not determinative, it was deserving of substantial weight because the decision was corroborated by record evidence establishing impairment.
Thus, the Court entered judgment in the claimant’s favor and refused to remand the claim back to CIGNA to further consider eligibility for the past due benefits. The open issues now involve whether attorneys’ fees and interest will be awarded by the Court.