Denied Disability Roller Coaster

San Diego, CARebecca was first approved then denied disability by Cigna. She had all but given up hope of getting any benefits until earlier this year. “I heard that CIGNA is settling some claims that were previously denied,” she says. “I’m wondering if they will reopen my wrongly denied disability claim.” Cigna’s settlement agreement is hailed as a major development for thousands of Cigna disability policyholders.

Rebecca lives in California, one of five states where consumers are having their claims reevaluated (the others are Connecticut, Maine, Massachusetts and Pennsylvania).

Rebecca says that Cigna denied disability benefits rightfully owed her by refusing to take into consideration her physician’s medical reports and ignoring a report by social security. Both these actions are “irregularities” that do not conform to national requirements as stipulated by the Department of Labor. As a result of Cigna denying or terminating claims, it has entered into a Regulatory Settlement Agreement and set aside around $77 million in claims that were previously denied and may now be overturned.

The Cigna agreement requires CIGNA subsidiary companies, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company and Life Insurance Company of North America, to undergo monthly monitoring and reporting to the Department of Insurance for a 24-month period, and reassess Cigna long-term disability denials for the residents of the five states, which occurred anytime in 2009 and 2010. In California, Cigna must also consider claim denials from 2008 to 2010.

Rebecca is hopeful that her long-term disability (LTD) claim, which was denied in 2008, will be reopened, and that “Cigna’s bad faith tactics will have an ultimate outcome of good faith,” she adds - optimistically.

“Due to my condition, I missed a few doctor’s appointments; even though my doctor explained to Cigna that I was suffering from agoraphobia [a fear of being somewhere where there is a chance of having a panic attack that others may witness, and not being able to get away] and couldn’t leave the house. When I appealed to Cigna to reconsider the claim, I was immediately denied (I had already received two checks, covering two months), even though Social Security approved my disability. I have been on social security disability benefits ever since - that would be a lot of money Cigna owes the government.

It just makes me furious that I paid into Long-Term Disability Insurance coverage with Cigna Group Insurance for so many years, through work. What’s the point? I did have a glimmer of hope when I heard about the government making Cigna set aside money for so many policyholders they have wrongfully denied.”

Cigna is not automatically paying denied claims. Rather, claimants who believe that Cigna acted in bad faith should seek legal advice from a qualified insurance attorney. First they will receive a letter from Cigna discussing a reassessment; second, claimants must notify Cigna of their right to have their claim reevaluated within 60 days of the date of the letter. After notifying Cigna, claimants should then seek a disability insurance attorney to help with the reassessment process, which won’t be easy: Cigna can still attempt to prove that they committed no wrongdoing.