We have recently seen an increase in clients denied long term disability insurance (“LTDI”) benefits by CIGNA Group Insurance, also known as Life Insurance Company of North America. Not only are CIGNA’s denials erroneous (our clients are unable to work and entitled to benefits under their insurance plans), but compared to other insurers, CIGNA’s review procedures are particularly egregious. Often, CIGNA’s denials blatantly disregard significant medical evidence supporting our clients’ restrictions. In many instances, CIGNA acts with complete irreverence to the deadlines required both by ERISA and their plans. If you have a disability claim with CIGNA, here are some things you should know.

CIGNA Paid Millions to Settle State Challenges to its Claims Handling Practices

In May 2013, CIGNA entered into a settlement with five states, California, Connecticut, Maine, Massachusetts and Pennsylvania, over improper disability claims handling practices. CIGNA agreed to pay fines and fees totaling $1,675,000 and allegedly set aside more than $70 million for claimants whose claims were denied as a result of CIGNA’s practices. The settlement resulted from state insurance regulators reviewing CIGNA’s practices, noting that, among other things, CIGNA was discounting medical information and social security decisions supporting claimants’ disabilities. Of note, CIGNA agreed to enhance its claim procedures by gathering Social Security Administration records, giving significant weight to Social Security Disability Insurance (“SSDI”) decisions, diligently gathering medical information, and clarifying vague or incomplete information with claimant’s treating providers. A copy of the settlement agreement may be found here.

Despite CIGNA’s multi-state settlement, Wisconsin disabled employees continue to fall victim to wrongful LTDI benefit denials as a result of biased claims handling practices. Two unfair practices our firm has observed recently are (1) CIGNA’s neglect of disabled employees’ SSDI award and (2) CIGNA’s noncompliance with deadlines.

CIGNA Must Consider Your Social Security Disability Insurance Award

CIGNA has been a repeat offender in its neglect of Social Security Administration findings. Insurance regulators recognized this when they required CIGNA to implement lengthy procedures concerning the review of SSDI awards. The Seventh Circuit Court of Appeals has also chastised CIGNA for mishandling an SSDI claim related to an individual’s claim for LTDI benefits. See Raybourne v. CIGNA Life Ins. Co. of New York, 700 F.3d 1076 (7th Cir. 2012).

LTDI insurers, such as CIGNA, must take the SSA’s disability finding into account. Usually, these insurers require you to apply for SSDI benefits. They may even assist in the process by hiring third party vendors, such as Allsup, Advantage Consultants, or Social Security Law Group, to represent you. If CIGNA has not explained why it has discounted an SSA decision supporting your disability, we may be able to help.

CIGNA Must Make a Decision on Your Appeal Within 90 Days

CIGNA has also frequently failed to comply with appeal review deadlines. According to federal regulations, CIGNA should decide your appeal within 45 days of its receipt of your request for review. 29 C.F.R. § 2560.503-1(I). CIGNA may obtain a 45-day extension to this time period, but assuming you have provided all necessary information for review, CIGNA must make its decision within 90 days. If the review drags on beyond the allowable time period, you may be better off pursuing your claim aggressively in court rather than continuing to wait for a decision. If CIGNA is taking an unreasonable amount of time to decide your claim, we may be able to help.

The preceding commentary is by no means an exhaustive list of the ways CIGNA or other disability insurers may have improperly handled your LTDI claim. If you believe you have been wrongfully denied disability benefits, please contact the disability benefit attorneys at Hawks Quindel, S.C.

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