CIGNA Long-Term Disability Insurance Company (Ep. 6, part 1/2)

Welcome back to another edition of Disability Insurance Law TV. My name is Gregory Dell and I'm joined by Cesar Gavidia and Steven Jessup and today we are here to discuss the Cigna Disability Insurance Company, which is the owner of Life Insurance Company of North America. Now throughout our brief discussion today, you're going to hear us refer to Cigna and Lena and the reason for that is because Lena is a subsidiary of the Cigna Corporation. Now one of the things we want you to know before we get going today is what type of company Cigna is. Cigna is a multi-faceted company that not only does long-term disability insurance but also does life insurance and health insurance. Now Cigna last year had revenues of $18.4 billion and profits before tax of $1.9 billion. So they are probably one of the largest disability insurance companies in the entire country and they have all of the resources and the power necessary to do whatever they need to do to fight any potential claims that they choose to deny. Now in this discussion today, we're going to review some of the cases that have been handled by Cigna recently and obviously all the cases we review were claim denials and that's why they ended up in court because the claims were denied. Our firm handles cases against Cigna on a nationwide basis and we've had the opportunity to see just about every kind of claim denial as well as claim approval and today we're going to discuss mostly cases that have been denied and then that were reversed by the courts. We're also going to discuss a recent California Department of Insurance regulatory decision in which Cigna and Lina were fined over $600,000 due to their unfair claims practices. So just to give you a pattern for some of the activities that go on by Cigna and we're not saying they deny every claim because they certainly do approve a certain percentage of claims but let's start with talking about the recent Department of Insurance investigation that took place and the results of that and I think, Cesar, you did some research into that and if you could talk to our viewers about that a little bit, that would be great. Sure. Well, you know, as you said, there have been developments out there in California. The California Department of Insurance and the insurance commissioner out there did an on-site investigation of Lina and of the records and found that the insurer had been engaging in numerous bad faith insurance practices such as making claims determinations prior to even receiving or requesting medical records and ignoring substantial new information after a claim had initially been denied. Now, what Lina and the California Department of Insurance essentially did to reach some middle ground in the settlement, Lina agreed to pay $600,000 in fines. They agreed to go back and reopen and review all denied disability claims from January 2005 through December 2007 using a new agreed upon quality standard which was outlined in the settlement agreement and, of course, cease and desist from engaging in bad faith practices and implementing new changes in policies and reviewing claims. All right, and Steve, I think that you took a look at some cases also to prepare for today in which Cigna showed a pattern of basically saying there's not enough objective evidence in order to approve this claim for disability and therefore were denying the claim but in actuality there was overwhelming evidence to support the claim and the courts found that way. But can you give our viewers an example of what was going on in some of the cases that you read? Yeah, and for you in case two, a lot of times we get Cigna cases, it's the same M.O. in the denial letters and the reasons why they're denying. But there was a case that came out in 2007 in Louisiana, the gentleman was a law librarian and law professor and he had multiple conditions and the insurance company was trying to specifically pick and choose which condition and they would take it separate and apart from the others and have a doctor review it and say, oh, no, it's not disabling in nature, and they say there's no objective evidence for this condition. Well, the court came back and said, listen, you haven't shown us any regulatory standards, any law or anything in your policy that the insured has to give objective evidence of beyond the fact that they had a doctor diagnose them and treated them for that condition and also that you have to take the conditions as a whole. When I take calls a lot and then Cigna, actually I had one today, a lady I spoke to today, it was the same thing. She had a litany of conditions that were all working together to cause the disability. It wasn't necessarily that one condition on its own was disabling, but taken in totality, it was. And the same thing happened in this case. And the courts came down very, very hard on Cigna with that saying, listen, how could you guys go and say you've given a good faith review on this claim when you're requiring things that don't exist in the forms of objective evidence they wanted and you're picking what you want to talk about and you're not looking at the totality of everything going into the claims. And in this one, the court awarded all back fees, back benefits going forward and then also attorney's fees on this case as well. I find we probably get five or 10 calls regarding a Cigna claim every week. And I would say from just the calls that I get, eight out of 10 of them was a denial error from Cigna where it says you have subjective complaints, but you don't have any objective evidence to support your disability. And I think that their people are just trained to say that as a matter of course, and they just ignore the objective evidences there and maybe hope that the person isn't going to appeal their denial or file a lawsuit if it's a private claim not governed by ERISA, although most of the Cigna claims are group claims, so you do have to file a lawsuit. So I don't know if that's a tactic to just make someone go away or if that's just their, they really truly believe there's no objective evidence there. And even in a recent appeal I filed on a Cigna group disability claim, there was objective evidence. We had MRIs of herniations throughout multiple levels of the spine, positive nerve conduction studies. The gentleman was a surgeon and their way to try to get around that is, well, it's a really important record that it was impairing in nature or what changed? You've been having these, the herniations have been there for a period of time. What's changed in the status of your condition? So they even try to find ways to get around the objective in that court. I'll give you guys a quote from a recent case. You know, we get tons of calls about fibromyalgia and chronic fatigue syndrome, things of which we all know there's no objective test to confirm that someone has fibromyalgia. And this was another case in which the court denied, I'm sorry, Cigna denied the claim saying you have no subjective evidence. And the court came back and basically said, by effectively requiring objective evidence for a disease that eludes such measurement, the insurance company has established a threshold that can never be met by claimants who suffer from fibromyalgia, no matter how disabling the pain. So if you can never meet the threshold, then basically you're selling a fictitious policy where if you have a subjective disabling condition, then you're never going to qualify for disability. So you know, fortunately for claimants who are watching this, the courts do most of the time make the right decision and don't buy into the, what I call the nonsense or the inappropriate reasoning or inappropriate claims handling by Cigna to say, we're going to deny your claim because you don't have objective evidence.