When it comes to long term disability claims, insurance providers, like CIGNA, do their best to minimize payouts and maximize premiums. For this reason, it can be difficult to go through the disability claims process alone. Nancy Cavey has years of experience as a disability insurance claims attorney and can guide you in filing a claim, and even help you if your claim was denied.
How CIGNA Began
The Insurance Company of North America (INA) got its start in Philadelphia in 1792 as the first marine insurance company in the United States. The Connecticut General Life Insurance Company was formed in 1865. These companies merged in 1982 to created CIGNA.
Where does LINA come into the picture? LINA is the Life Insurance Company of North America and was founded in 1956. It offers group life, accident, and disability insurance and is a subsidiary of Connecticut General. CIGNA is the parent company of Connecticut General and LINA and they all operate under the same business model. I lump them under the umbrella of CIGNA.
CIGNA is an American based worldwide company that provides medical, dental, disability, life and accident insurance through employers, governmental and non-governmental organizations, unions and associations. It had a yearly revenue of 41.616 billion dollars in 2017 in the United States alone.
It has been accused by the Securities Exchange Act of earnings manipulation, has a history of denying 39.6% of group health claims in California alone, and has a history of biased disability claim administrative. CIGNA entered into a regulatory settlement agreement for the use of biased medical and vocational providers and its failure to give appropriate weight to a Social Security disability award in its disability claims decision.
The result was a temporary correction in CIGNA’s claims handling process. Unfortunately, it has returned to the bad behavior that got it into trouble, to begin with. Only now, CIGNA knows how to cover its tracks much better.
CIGNA’s Current Disability Claim Denial Strategies
Cigna is back to playing games with initial applications and making endless and multiple requests for medical, financial and vocational information before it figures out a way to deny benefits. This delay and denial strategy drains the policy holder’s bank accounts as they try to stay financially afloat.
Using old tricks such as “liar for hire” doctors who give CIGNA the ammunition it needs to justify a claims denial or termination, CIGNA rarely tells a denied policyholder the real reasons the claim was denied. Worse yet, CIGNA fails to fully explain what the denied policyholder needs to submit to successfully win an appeal. That’s why it is crucial that you be represented at both the initial application and appeal stages of a CIGNA claim by an experienced disability lawyer who battles CIGNA daily.
Long Term Disability Scams Committed by CIGNA
CIGNA has an MO for denying Long Term Disability claims. I believe it’s almost become a pattern and practice. Here are some common trends that we see in CIGNA Long Term Disability claim denials:
Misrepresentation of the policy terms.
It’s not often that they’ll tell you that you are at any occupation stage of the disability claim as opposed to your own occupation. They’ll even tell you that you have to apply for Social Security Disability when the policy doesn’t actually require it.
It’s important in any CIGNA claim that you consult with an experienced CIGNA disability attorney such as Nancy Cavey who can review the denial letter and your policy to see whether or not CIGNA is playing fair.
Making decisions to terminate and then, only after the fact, gather evidence to justify the denial.
ERISA rules and regulations require a full fair review of your claim. CIGNA is a fiduciary, which means that they are supposed to be acting in your best interest in considering your disability claim. CIGNA, rather, has a history of denying the claim and then justifying your denial after the fact. If your CIGNA claim for disability benefits has been denied for just this reason you need legal representation.
Using a PAAF to misrepresent your functional capacity.
Any Long Term Disability carrier is going to deny your claim that there is medical evidence that you can work at least sedentary capacity. Sedentary is basically loosely defined as work that can be done sitting down, but which may involve standing and sitting, and upper body motion. CIGNA will take the medical records and cherry-pick them so that they can conclude that you can work in at least a sedentary capacity. Then they march blindly to a decision to terminate your benefits and, only after the fact, with one push justify their wrong decision.
FAQs About Cigna Disability Claims
How Does Cigna Short-Term Disability Work?
Do you have short-term disability coverage through Cigna? If so, it is crucial that you understand how your policy works. Short-term disability coverage provides protection and financial security to people who are temporarily disabled due to an illness, injury, or medical condition.
Cigna short-term disability insurance is generally subject to a seven-day elimination period. In effect, this means that a policyholder may qualify for benefits exactly one week after the onset of the condition. In other words, disabilities that last for less than one week are typically not covered by a Cigna short-term disability insurance plan.
With short-term disability coverage, payments depend on several different factors. While policy terms can vary considerably, Cigna short-term disability insurance may cover up to a maximum of 60 percent of an applicant’s weekly gross earnings. Though, some policies only cover 40 percent of a worker’s pre-disability earnings. In addition, most Cigna disability policies usually carry a maximum weekly benefit of $1,000.
What Does Cigna Short-Term Disability Cover?
Short-term disability insurance is a form of wage protection. In order to qualify for financial benefits through Cigna short-term disability policy, a policyholder or beneficiary must be disabled as the result of a covered illness or a covered injury. Cigna’s short-term disability insurance plans may provide coverage for the following:
- Accidental injuries;
- Sickness or illness; and
- Other disabling medical conditions.
In applying for short-term benefits through Cigna, an applicant must provide proof of earnings and continued disability. Cigna defines a disability as a covered injury or illness that makes an applicant unable to perform the material job duties of their regular occupation. Of course, material job duties vary from position-to-position. For this reason, it is sometimes easier to qualify for disability benefits if you have a physically demanding job. In preparing a claim, make sure that you present strong, compelling evidence that clearly demonstrates how a disability/injury/illness prevents you from working on a full-time basis.
How Long Does Cigna Long-Term Disability Last?
The duration of Cigna long-term disability insurance will depend on the specific terms of the policy. As a baseline, Cigna’s long-term disability policies typically provide coverage for at least two years. Though, many of Cigna’s plans cover five years or ten years of benefits. Long-term disability benefits typically always expire when a work reaches retirement age—which is either 65 or 67, depending on the terms of the Cigna disability policies.
Once long-term disability benefits run out, other options might be available. In some cases, it may be advisable for an individual to seek Social Security Disability Insurance (SSDI) benefits. Be sure to check the terms of your specific Cigna disability plan to confirm the maximum duration of long-term disability benefits that are available. If your Cigna long-term disability benefits are about to run out, an experienced attorney can help you understand your options for seeking additional financial support.
Contact Nancy Cavey if Your CIGNA Disability Insurance Claim Was Denied
Some CIGNA policyholders make the mistake of going it alone and they pay dearly for “doing it yourself.” We recommend you hire a seasoned professional attorney that knows how to take on the big insurance companies on your behalf. If you are a CIGNA Long Term Disability carrier who has been ambushed by this pattern and practice, contact CIGNA disability benefits denied attorney Nancy Cavey. Don’t let CIGNA rob you of the benefits you deserve.