Over the years, we have seen patterns in phone calls and emails that almost always indicate that some sort of change is underway at a disability insurance company, and the end of 2014 provided another example of this. We found that we were getting an increasing number of phone calls concerning Cigna disability insurance policies and actions taken against long term disability insurance ERISA claimants. While we have not yet uncovered the exact reason why this occurred, there are a few things that we do know for sure about Cigna, and we hope they may be helpful to our readers and to the disability insurance community.
Cigna has denied many claimants their disability insurance benefits without actually conducting a live, face-to-face physical examination of the claimant. How can an insurer properly make such a determination, based solely on paper files? Unfortunately, some Courts permit this as acceptable in ERISA cases.
Consider it from the viewpoint of Cigna: if they deny or terminate 1,000 claims, and just 10% of all the claimants do not know that they can fight back against the denial or termination of their long term disability insurance claim, and 10% try to handle the denial or termination themselves, but because they don’t meet the tight deadlines for appeals, or some other procedural error excludes their appeal, Cigna has saved itself from having to pay 20% of their claims and incurred only the cost of preparing the letter. Postage is cheap.
The next step is to look at how well, or how poorly, insurers like Cigna conduct paper reviews of the medical records. Our experience here has been that either Cigna or the third party vendor companies that they hire to review medical records are repeatedly flawed. Just page through this blog and you’ll find that Cigna is not the only company to do poor paper reviews, but it seems that Cigna has a sizable number of incomplete medical reviews or are otherwise lacking in quality. Many times, the materials provided to these paper only reviewing doctors are lacking key records.
Now consider how many people try to fight those incomplete medical reviews on their own and fail. The challenges get more complex as one moves through the appeals process. The average person does not understand the strict limitations of the appeals process, in particular the requirements and restrictions on the medical records as proof of disability. Doctors who do not know the process add to the difficulty of preparing a claim properly. This can be fatal to a claimant’s ability to secure relief.
A failure to properly and thoroughly address a flawed medical review, through no fault at all of the claimant, adds another group of people who try and fail to fight their denial. As you can see, the statistical advantage of treating claimants in this manner works heavily in Cigna’s favor in these ERISA cases.
Our years of experience representing ERISA clients who have had their disability benefits denied or terminated by Cigna gives us the insight to help our clients. We know the soft spots in Cigna’s defenses and use this knowledge to work with our clients when their claims have been denied or terminated. You can learn more about Cigna and a multi-million dollar settlement that lends further credence to our position that Cigna is not a claimant’s best friend by clicking here.
If you have had a long term disability insurance claim denied or terminated by Cigna because of an incomplete or otherwise flawed paper review of your medical records, call our office today at 877-LTD-CLAIM (877-583-2524) to learn how we can help. Please be aware that there are strict limits on the time to appeal ERISA claims, so don’t wait to call us and see how we can help.