Here at the Disability Legal Center we believe that nobody who is no longer able to work should be denied long term disability (LTD) benefits they deserve from their Cigna LTD policy.
Unfortunately, Cigna has a reputation for unreasonably denying claims. This denial of benefits deprive disabled workers and their families from much needed income replacement. It's terrible they can get away with this without punishment or repercussions.
If this happens to you, you need to appeal the denial and then, if necessary, file an ERISA long term disability lawsuit against Cigna in federal court.
If your Cigna policy was purchased by your employer, it is likely covered by ERISA, the federal law which covers most employee benefits. ERISA has several different rules compared to state civil laws. One of the big requirements is that you must exhaust all administrative appeals before filing a lawsuit.
Most policies are similar, but differences can be significant. Most policies will require one appeal, and the appeal must be made within a certain amount of time, usually 180 days after the denial of benefits. While 6 months seems like a long time, putting together an effective appeal can take a few months alone. The appeal is actually the most important step in this process.
Your appeal of Cigna's denial of benefits is the last chance you get to submit new evidence. If your appeal is denied, and you have to file a lawsuit in federal court, you do not get to submit any new evidence. The federal case will be limited by the claims file and appeal.
This is significant. Your appeal must include anything you want a judge to review later, because you will not have a chance to add any new documents later.
If your Cigna LTD benefits have been denied, you must consult with a disability lawyer right away. Give us a call immediately, at (866) JOE-DANG or (866) 563-3264 to schedule your Free, No Obligation case review. You must act immediately to preserve your rights, or they may be lost forever.
Sometimes the appeal is granted, and you are put back on claim or reach a buyout settlement with Cigna. Other times however, and probably more often than not, your appeal is denied as well. That leaves you with one choice: to file an ERISA disability lawsuit in federal court.
We will help you file the ERISA suit, and prepare all necessary documentation for the court review process. With a proper appeal, most of the evidence is already contained within the administrative record.
Keep in mind, not all LTD claims are covered by ERISA. If your plan is not covered by ERISA, you can file in state court, which offers policyholders greater protections.
A lot of CIGNA plans are denied or terminated due to the hybrid standard CIGNA employs. During your first two years of receiving benefits, the standard for disability is whether you can perform your "own occupation." This is the occupation you were engaged in at the time of disability.
After a set period of time, usually two years, the standard changes to "any occupation." Meaning, you have to prove you cannot perform any occupation or your benefits will be terminated.
And indeed, this is the point in time when a significant amount of Cigna plans are terminated.
In 2013, CIGNA reached a settlement with five state departments of insurance, California, Connecticut, Maine, Massachusetts, and Pennsylvania.
During an investigation of Cigna's claims examination practices, the insurance department officials found numerous claim handling irregularities, such as:
Cigna was forced to re-evaluate certain claims, and they set aside $77 million to pay policyholders whose claims were not handled properly. Cigna had to pay $500,000.00 to California so that California's insurance department could provide ongoing monitoring of their claims handling practices.
Under the settlement agreement, the companies are required to:
As you can see above, you are not dealing with an insurance company that has your best interests at heart. They are here to make money, and to do that they need to collect as much premiums as they can, while paying as little in benefits as possible. Great for them, bad for you.