Long-term disability (LTD) insurance can be incredibly important — perhaps even more critical than life insurance. LTD benefits offer monthly payments in the event that you are unable to work due to a disability. These payments can provide a financial lifeline in a time of difficulty.
Too often, however, insurance companies that offer these policies make it difficult to access the benefits of your policy. Whether it is an opaque claim process, unreasonable denials, or wrongful termination of benefits, there are many ways that insurance companies may deny you what you are due under your LTD insurance policy. One insurance company known for these types of denials is Cigna.
Based in Bloomfield, Connecticut and Philadelphia, Pennsylvania, Cigna is a worldwide insurance company. In 2018 alone, Cigna had a revenue of over $48 billion. Yet despite these astoundingly high revenues, Cigna may unjustly deny your LTD claim.
There are a number of methods that Cigna may use to get out of paying your LTD benefits. Having a New Jersey disability benefits lawyer can help you put together a strong application, and potentially avoid a denial. If your Cigna disability claim is denied, your lawyer can advocate on your behalf with an appeal and potentially a lawsuit.
Why Does Cigna Deny So Many Long-Term Disability Claims?
Like other insurance companies, Cigna makes money by collecting premiums for its products — not by paying out on its policies. However, Cigna’s practices in denying long-term disability claims were so bad that it led to a joint investigation by five separate states.
In 2013, Cigna paid a $77 million settlement after an investigation into wrongful denials of long-term disability claims and improperly terminated benefits payments. The investigation was conducted by insurance commissioners in Connecticut, California, Maine, Massachusetts, and Pennsylvania. Examinations found that Cigna:
- Failed to use reasonable standards for the prompt investigating and processing claims;
- Unreasonably denied claims in cases where it knew that information that would likely entitle a policyholder to benefits existed, but was not obtained or reviewed prior to the denial;
- Failed to perform any functional testing or peer review of medical records;
- Failed to consult with health care professionals who have appropriate training and experience in the field of medicine involved;
- Failed to provide complete information in the file to the health care expert performing a medical review of the records;
- Failed to clarify a claimant’s restrictions and limitations with the attending physician who was supporting disability;
- Failed to consider independent physician findings;
- Discounted Social Security disability decision findings; and
- Failed to appropriately consider workers’ compensation records.
As a result of this settlement, Cigna agreed to adopt enhanced settlement procedures, including:
- Giving more appropriate consideration to awards of Social Security Disability Income (SSDI);
- Gathering and analyzing medical records for the claimant’s full medical history;
- Enhancing its use and selection of External Medical Resources;
- Providing full and complete documentation to its various vocational and medical resources.
While this settlement may have addressed the immediate issues in these states, there is no guarantee that Cigna is not using these same tactics — or similar methods — to deny claims in these or other states. Your Cigna claim may be subjected to processes that have already been subjected to a massive, multi-state settlement, leading to an unfair denial of your benefits.
For example, Cigna may deny your LTD claim based on inadequate documentation of a disability, despite knowing that there are multiple medical records available that it simply has not yet received. This means that even though there is concrete evidence that you have a disability that prevents you from working — such as diagnostic test results —your claim may be denied because Cigna issued a decision before reviewing that information.
Fighting Back Against Cigna Disability Claim Denials
If Cigna denies your claim for LTD benefits, then the next step in the process is typically to file an appeal. There is a specific time frame to file an appeal of a denial of benefits, which is set by federal law or by your insurance policy. It is important to file your appeal by that deadline, or you may lose your ability to appeal the decision.
If Cigna grants your appeal, then you will receive benefits. However, if your appeal is denied, then you may choose to file a lawsuit. Putting together a strong appeal that addresses each point of the denial can help you avoid the need for a lawsuit.
Most long-term disability policies are governed by a federal law known as the Employee Retirement Income Security Act of 1974 (ERISA). A lawsuit for denial of LTD benefits will either be filed in federal court if your policy is covered by ERISA, or in state court. A skilled New Jersey disability benefits attorney can work with you to help you determine the best course of action for filing a claim.
How a New Jersey Disability Benefits Attorney Can Help
Cigna has a long history of denying long-term disability claims, making it difficult for you to get the benefits that you are due when you need them most. This can put a financial strain on you, just as you are also coping with a medical or mental health issue. An experienced New Jersey disability benefits attorney can help you avoid a denial of benefits, first by crafting an airtight application for benefits, and then by monitoring your claim and advocating for you through each step of the process.
For more than 20 years, Bross & Frankel has helped clients obtain the benefits that they need when they are unable to work due to a disability. We have a deep understanding of the law, as well as compassion for individuals going through a difficult time. Contact our office today at 856-795-8880 or online to schedule a free disability claim review.