Oregon LTD Insurance Woes Are a Day in the Life of Insurance Frustration

Portland, ORCigna has long been a provider of short- and long-term disability (LTD) coverage for consumers and employees in various states, including Oregon. However, Cigna is also not unlike other insurance providers who have been accused of Denied Disability Claims, regardless of legitimacy of the claim. Anyone having filed an Oregon Long term disability lawsuit in Oregon would be forgiven for feelings of vindication after noting some other examples of legal hot water Cigna finds itself in.

In one example, a former insider of both Cigna and another entity is alleging that Cigna and the other party have colluded to increase health insurance premiums in an alleged effort to defraud Medicare and private insurance members.

In a release from PR Newswire (10/29/14), whistleblower Pete Bonewitz accuses Cigna of artificially increasing premiums through the application of incentives, strategic claims acceptance and by leveraging weakness in ICD-9 coding systems. Bonewitz also alleges that the other party - Zotec Partners - has been coding false claims to meet Cigna’s requirements.

“Together, Cigna and Zotec Partners’ unscrupulous methods have made disputing medical bills enormously convoluted with the intent of placing an unnecessary burden on members,” Bonewitz says in his whistleblower lawsuit. “This manipulative process has resulted in artificially increasing the risk of ALL (original emphasis) Cigna members.”

Bonewitz claims he was wrongfully terminated from both companies after attempting to bring his concerns to their attention. His 51-page bad faith insurance civil lawsuit was filed in the Circuit Court for Davidson County at Nashville (14c-4350, 3:14cv0096 and 1:2014cv01464).

Meanwhile, anyone considering or having filed an Oregon bad faith insurance lawsuit might be interested in knowing about another allegation that involves Cigna and another funder of health care services, Blue Shield. According to the Ventura County Star (9/26/14), plaintiffs accuse the two insurers of participating in a bait and switch scheme that allegedly left many consumers out in the cold after they signed up.

Plaintiff Kevin McCarthy, together with his wife Jane, is the lead plaintiff in a proposed class-action lawsuit that could have as many as 410,000 class participants, according to the report. McCarthy is self-employed. When he signed himself and his wife up for coverage with Blue Shield as part of the new health reforms, he claims to have duly checked the provider’s website and noted that his doctor and team of health care providers were a part of the Blue Shield network. He said his doctors also confirmed this, as did those who provided health care for his wife.

It was only after making a claim for health care services and becoming shortchanged did he learn that their health care providers were no longer considered to be in the Blue Shield network.

“I am upset,” McCarthy told the Ventura County Star. “After all the calls we made to Blue Shield, the hours - the hours - we spent on hold,” he said.

A similar thing happened to plaintiff Sheila Davidson. According to a release from Targeted New Service (9/25/14), Davidson also did her due diligence and confirmed through the Cigna website that all of her health care providers were in Cigna’s network. “I did a lot of research,” she said.

“At the beginning of the year, Cigna even covered my medical care.

“Then, Cigna suddenly switched all my doctors to out-of-network status leaving me with the bill. Cigna refused to cover my continued care with my physicians. Now I am left with thousands of dollars in medical bills and I am scared to continue treatment or use my Cigna plan.”

Davidson’s attorney accuses Cigna of baiting consumers like Davidson into signing up for care, then changing the network status of her health care providers mid-year and mid-treatment, without warning.

Oregon Long term disability fraud insurance, in all likelihood, sees some parallels to the kind of alleged misrepresentation seen here.

The class-action lawsuit against Blue Shield of California (Case No. BC558549) and Cigna (Case No. BC558566) was filed in Los Angeles County Superior Court.