Why Cigna Denied Your Disability Insurance Claim
Tuesday, April 13th, 2021
CIGNA is a global health and disability insurance company selling and administering group disability insurance policies for large and mid-sized employers through its Cigna Life Insurance Company of New York (in New York State) and in all other states through Life Insurance Company of North America (LICNA). LICNA also provides administrative services for self-funded disability plans, when a company pays benefits directly.
In late 2019, New York Life announced that it was buying Cigna’s disability, accident, and group life insurance business. Since that time, we have seen an uptick in Cigna disability claims. The change may have been caused or impacted by the “legacy” status of CIGNA claims during the sale to New York Life; that is, reviewed to determine if they can be closed (terminated) or otherwise impacted. This occurs often when insurers sell their block of coverage.
Frankel & Newfield represents many people who have had their disability insurance benefits denied by Cigna. Having to fight for your disability benefits when you are suffering from a illness or injury is a terrible burden. That’s where we come in.
What reason does Cigna give for your disability claim denial?
There are certain tactics that Cigna uses to attempt to terminate a disability claim. Here are some that we encounter on a regular basis:
“No contemporaneous records of ongoing impairment.”
Certain conditions require regular visits to doctors, physical therapists, infusion centers, etc. But if you have an injury or illness that does not require you to see a doctor on a regular basis, Cigna and other disability insurance companies will argue that you must be healthy enough to resume your daily activities, including working.
Disability claims under Cigna will do better with a regular pattern of doing to see your treating physician, regardless of whether you or your doctor feel these visits are necessary. A disability insurance company like Cigna is looking at data: number of visits, diagnostic tests, procedures. Your own description of limitations does not count.
“No findings on examination.”
This reason for terminating a claim often follows a telemedicine visit, where a doctor who has incomplete or no information about your disability conducts a short video call and reports that you are still suffering from a condition, but there are no “findings on examination”. Disability can hardly be diagnosed over a mobile phone screen. As telemedicine visits have become more accepted in mainstream medicine, disability insurance companies have found them to be useful in denying or terminating claims.
“Peer reviews indicate no disability exists.”
A peer review physician is a physician paid by the insurance company, for a medical review that purports to be independent and free of bias. This is an oxymoron – a truly independent physician would not be paid by either party to a claim. The doctor is supposed to be a specialist in the field of medicine of the disabling condition(s).
This is also known as a battle of disability experts, where the diagnosis and treatment of the claimant’s treating physician is set against the evaluation of a peer review physician. The opinions of both physicians often do not agree, for several reasons:
- The peer review physician may not have been given the entire medical record.
- The peer review physician is being paid by the insurance company and cannot be free of bias.
- The peer review physician has not seen the claimant for an examination, or over time, and does not have the extensive knowledge of the individual case, but rather a two-dimensional consideration of the medical records.
- The peer review physician is not always the right medical specialist for the claimant.
A defective peer review is not unusual for Cigna; we have successfully fought against these defective peer reviews and won. We take a deep dive into the credibility and authority of the peer reviewer, and pair that with a lack of bias. We also attack peer reviews that are not based on the claimant’s entire medical record and address the substantive flaws in the review. Our position is that any professional retained by the insurance company has a financial interest in a finding that supports the insurance company’s position. But we attack the substance with intensity to ensure that the treating physicians’ opinions are properly considered.
Flawed vocational assessments are used to deny or terminate disability claims.
An out-of-date occupational reference used for descriptions of the tasks and duties is something we see on a regular basis. The Dictionary of Occupational Titles should have been retired decades ago – citations on the home page are from 1970 and 1980 – but it’s the reference used for many denials. The Occupational Information Network (O*NET) from the Department of Labor is an up-to-date resource, updated on a regular basis and includes jobs that did not exist in 1970 and 1980.
Why would a long-term disability claim be denied by Cigna?
The long-term disability claim that you file is a cash liability for Cigna. When a claim is denied, it is less cash that has to be disbursed. During the time that the claim is denied, the insurance company is profiting from investments made possible by premiums. Remember, there is no penalty upon insurers in ERISA disability insurance cases for delayed payments, so whether benefits are paid at the start of the year or at the end of the year, the only losses are yours.
The insurance sector depends upon finance and economics, investments, and interest rates. Premiums fund those investments, and protecting them is how insurance companies earn billions of dollars. Your personal situation is a drop in the bucket to the insurance companies, even when it’s a financial disaster for you and your family. COVID-19 has surely impacted companies, through excessive mortality (death claims) and disability claims.
What can you do to protect your short and long term disability claim?
Talk with one of our attorneys about your disability claim. We offer a free telephone consultation and will review your situation. It is possible that your claim is one of many that are the direct result of a merger, or a third-party administrator that needs to tighten up the approval process at the instruction of a major insurance company. Or, you may have a condition that disability insurance companies find is easy to challenge. Whatever your situation, a conversation with our office will provide you with information to help you take the next step.
If your disability claim has been denied or has been terminated, don’t wait to defend yourself. There are strict time limits for disability claims, and you could risk your legal right to fight back. Call Frankel & Newfield at 877-LTD-CLAIM (877-583-2524) today.