Disability Insurance Archives - Page 36 of 44

California Court of Appeal Finds That a 10:1 Ratio Between Punitive Damages and Compensatory Damages Awards Satisfies Due Process

A 10-to-1 ratio of punitive damages to compensatory damages awards in an insurance bad faith case passes Constitutional muster. So says the California Court of Appeal in its decision in Nickerson v. Stonebridge Life Insurance Company, __ Cal. App. 4th ___, 2013 Cal. App. LEXIS 583 (2013). The decision is significant in that it affirms that punitive damages are not limited to a single-digit ratio and that a ratio of punitive to compensatory damages of 10-to-1, and perhaps higher, falls within the maximum permitted under due process. Additionally, the decision clarifies what damages may be included in fixing the ratio of compensatory to punitive damages.

The Nickerson case concerns a disabled veteran, Nickerson, who was covered under a policy providing coverage for hospital confinement, intensive care unit and emergency room visits issued by Stonebridge. After suffering an injury to his leg, Nickerson was hospitalized for over 100 days. However, Stonebridge contended that only a small portion of the time Nickerson stayed in the hospital was considered “Necessary Treatment” under his policy. On this basis, Stonebridge denied benefits for the rest of the time Nickerson was hospitalized.

Following the denial of his benefits under the policy, Nickerson filed a claim against Stonebridge for breach of the insurance contract and for breach of the implied covenant of good faith and fair dealing. The trial court found that Nickerson was entitled to $31, 500 in unpaid benefits for the breach of contract cause of action. The jury returned a special verdict finding Stonebridge’s failure to pay policy benefits was unreasonable and that Nickerson suffered $35,000 in damages for emotional distress. Finally, the jury awarded Nickerson $19 million in punitive damages, which constituted 5% of Stonebridge’s net worth. Stonebridge immediately moved for a motion for new trial seeking to reduce the punitive damages award. The trial court conditionally granted a new trial unless Nickerson agreed to accept a reduction of the punitive damage award to 10 to 1 in accordance with “recent California and federal authority.” In calculating the amount of punitive damages, the trial court only included the $35,000 in compensatory damages for bad faith and did not include damages for the insurer’s breach of contract or the $12, 500 in attorney’ fees awarded to Nickerson pursuant to Brandt v. Superior Court, 37 Cal. 3d 813, 817 (1985) (when the defendant insurer’s tortious conduct forces insured to retain counsel to obtain policy benefits, the insurer is liable for attorney’s fees). Thus, the trial court offered Nickerson a reduction of punitive damages to $350,000.

Nickerson rejected the trial court’s offer and appealed, arguing that the trial court erred (1) in concluding it was constrained by law to limit punitive damages to no more than 10 times the compensatory award; and (2) in excluding certain categories of compensatory damages.

The Court of Appeal began its analysis by reciting that a punitive damages award violates the due process clause of the Fourteenth Amendment if the award is “grossly excessive.” In determining whether the trial court’s remittance of the jury’s award of punitive damages to a 10-to-1 ratio with compensatory damages was constitutional, the court followed the three guideposts set out in BMW of North America, Incorporated v. Gore, 517 U.S. 559, 575 (1996): (1) the degree of reprehensibility of the defendant’s misconduct; (2) the disparity between the actual or potential harm suffered by the plaintiff and the punitive damages award; and (3) the difference between the punitive damages awarded by the jury and the civil penalties authorized or imposed in comparable cases. As to the first guidepost, the court found that the degree of reprehensibility factor weighs in favor of Nickerson because, although Nickerson did not suffer physical harm, Stonebridge acted with indifference toward Nickerson’s health and safety, Nickerson was a financially vulnerable individual, Stonebridge’s conduct was intentionally deceitful and was not an isolated incident. The court did not consider the third guide post relating to comparable civil penalties because Nickerson conceded that this guide post was of “limited utility.” Turning to the second and most important guidepost, the court noted that the Supreme Court has consistently refused to establish a ratio beyond which a punitive damage award could not exceed, but that awards significantly exceeding a single-digit ratio between punitive and compensatory damages generally will not satisfy due process. The court then stated that the California Supreme Court has found that ratios significantly greater than 9 or 10-to-1 are suspect and may not pass constitutional muster absent “special justification.” Based on both federal and state case law, the court concluded that the message gleaned from these cases is that due process analysis is flexible and the constitutionality of any award must be based upon the particular facts and circumstances of the case.

Based on its analysis of the three guideposts, the circumstances of this case, the high level of reprehensibility of Stonebridge’s conduct, Stonebridge’s net worth and the small economic damage award justifies an outside constitutional limit of a 10-to-1 ratio of punitive to compensatory damages. As such, the Court of Appeal upheld the trial court’s decision to remit the jury’s award to a 10-to-1 ratio.

Additionally, it is important to note that the court also addressed what categories of compensatory damages are included in calculating the ratio of punitive to compensatory damages. Nickerson argued that “uncompensated potential harm” should be included into the calculation. However, the court rejected this argument because Nickerson was fully compensated for his emotional distress injuries. The court also refused to include the $31, 500 in policy benefits awarded to Nickerson because, citing Major v. Western Home Insurance Company, 169 Cal. App. 4th 1197, 1224 (2009), punitive damages are not authorized in contract actions. The court also refused to include attorney’s fees awarded pursuant to Brandt because they were awarded after the jury awarded punitive damages. However, it should be noted that if the jury had awarded attorney’s fees, they would have been considered in determining if the ratio of punitive damages to compensatory damages is excessive because Brandt fees “are considered extra contractual tort damages that compensate a plaintiff for an insurer’s bad faith refusal to pay policy benefits.” Id (emphasis in original).

The Nickerson decision is highly significant in that the Court of Appeal made it clear that punitive damages awards are not limited to a single-digit ratio and that there is no bright line maximum ratio of punitive damages to compensatory damages required by due process. Although the court strongly suggested that a punitive damage award significantly exceeding a 9 or 10-to-1 ratio could violate due process, the court refused set the 10 to 1 ratio as a maximum cap on all punitive damages awards. Indeed, given the highly flexible due process analysis adopted by the court, instances where insurers engage in significantly reprehensible acts of bad faith, as determined under the guidepost analysis, may well justify a punitive to compensatory damages ratio which exceeds the 10-to-1 ratio applied in Nickerson.

FAQs: What do you need to know about long-term care insurance?

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith, life insurance, long term disability insurance, annuities, accidental death insurance, ERISA and other areas of the law. This article in that series focuses on long-term care insurance.

What is long-term care insurance?

Long-term care insurance refers to coverage for health care and treatment in extended care facilities (for example, convalescent homes, nursing homes, etc.), at-home health care and/or adult day care for individuals (usually above the age of 65 or with a chronic or disabling condition that needs constant supervision) rather than in an acute care unit of a hospital. See California Insurance Code § 10231.2 et seq. Long-term care insurance is designed to pay for care that is generally not covered by health insurance, Medicare or Medicaid.

Long-term medical care is typically expensive but can be an important part of financial planning for single persons and families. This insurance is designed to cover out-of-pocket expenses for long-term care, and assists those who purchase it from relying on children or other family members for support in the latter years of life.

Insurers often deny these claims interpreting facts and the law in a manner that unfairly and unreasonably favors their financial interest in denying claims.

When is an insured eligible to receive long-term care insurance benefits?

While the specific coverage offered by long-term care insurance may vary, typically, an insured is eligible for long-term care benefits if he or she is unable to perform at least two or more activities of daily living without substantial assistance. “Activities of daily living” will be a defined term in the insurance policy, but normally, activities of daily living include eating, dressing, bathing and attending to other personal hygiene, walking and toileting without assistance. Most policies provide benefits when and insured is diagnosed with a severe cognitive impairment such as Alzheimer’s or Parkinson’s disease.

What should an insured do if the insurer denies a long-term care insurance claim?

In an insurer denies a claim for long-term care insurance, then the next step would generally be to bring a civil lawsuit against the insurer, as there is typically no requirement that the insured submit an appeal. However, an insured should review the policy and denial letter to ensure that he/she has completed all the necessary steps for claiming long-term care benefits. After doing so, the insured should consult with an experienced insurance attorney regarding bringing a civil action. Most attorneys, including the McKennon Law Group PC, will take a meritorious case on a contingency fee basis (meaning the insured does not pay a fee unless there is some type of recovery from which a fee may be earned).

In the rare instance that the long-term care insurance was provided and paid for by the insured’s employer, the policy is most likely governed by ERISA. In this case, then the insured cannot immediately file a civil action to recover long-term care insurance benefits until he/she appeals the initial claim denial. ERISA requires that the insured first appeal the initial determination in accordance with procedures contained in the plan documents/policy. Under the Department of Labor Regulations, an insured has no more than 180 days to appeal a denial decision relating to long term care insurance benefits. If the insured does not timely appeal an adverse benefit decision, then he/she may lose the right to collect benefits under the Plan. When an insurer denies an insurance claim made under an ERISA-governed policy, it is required to advise the insured of the specific reasons for the denial and describe any additional material or information necessary to perfect the claim. Additionally, the insurer must inform the insured of the plan’s review procedures and inform the insured of his/her right to file a subsequent civil action. However, the insurer never tells the insured that he/she will not be allowed to use new evidence to support a subsequent civil action. Because the insured may be limited to the information contained in the Administrative Record in the lawsuit, it is crucial that the Administrative Record contains all information that supports the insured’s long-term care insurance claim.

As such, following denial of a long-term care insurance claim, the insured should immediately consult with an experienced long-term care insurance attorney and discuss whether to appeal the insurer’s initial decision or proceed to a lawsuit. As discussed above, time is of the essence and the insured does not want to risk losing long-term care insurance benefits by failing to file a timely appeal. But, if an appeal is required, the insured should not simply submit an appeal stating that he/she disagrees with the insurer’s denial decision. The insured should have an attorney prepare the appeal and ensure that the file contains all of the documents and information needed in a subsequent lawsuit. Specifically, a qualified attorney can help the insured review the insurer’s often voluminous records and identify any problems or irregularities in its initial denial. An experienced attorney can also ensure that these problems or irregularities are noted in the Administrative Record and are backed up by applicable case law citations. Moreover, when confronted with the arguments of experienced ERISA attorneys such as McKennon Law Group PC, the insurer or plan administrator will often reverse itself and approve the claim for benefits without the need to file a lawsuit.

If the matter is not governed by ERISA, then state law claims will apply, such a breach of contract and insurance bad faith. These allow for a broader array of damages, including compensatory damages caused by the insurer’s bad faith, emotional distress, and punitive damages. Furthermore, under California law, an insured may be able to bring additional claims under Bus. & Prof. Code section 17200 and California elder abuse law, that potentially allows for treble damages.

For more information about long-term care insurance, visit our full FAQ regarding this topic located here.

FAQs: Should You Hire an Attorney to Help You With Your ERISA Appeal?

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog that deal with frequently asked questions in the insurance bad faith, life insurance, long term disability insurance, annuities, accidental death insurance and ERISA areas of the law. This article in that series focuses on appealing a denial of your long term disability insurance claim for long term disability insurance benefits under ERISA.

The short answer is “Absolutely.”

If your claim for benefits under an ERISA plan is denied, you cannot immediately file a lawsuit to collect your benefits. Instead, you are required to file at least one appeal with the very same company that denied your claim in the first place. While the insurance company is perfectly happy to allow you to conduct the appeal without the help of an attorney, by doing so, you might be handicapping your chances of winning a lawsuit if/when the company denies your appeal.

When you appeal the denial of your claim for benefits, the insurance company NEVER TELLS YOU that you will not be allowed to use new evidence to support your claim in your lawsuit. In most cases, you will instead be limited to the documents in the insurance company’s file, called the Administrative Record. Thus, the worst thing you can do is simply tell the insurance company that you disagree with their decision and would like to appeal. But if you hire an attorney who has strong experience handling ERISA matters, including litigating them, that attorney can help ensure that your file contains all of the documents and information that you will need in your lawsuit and help to ensure that you timely file your appeal (if your appeal is not filed at all or if it is not timely, you may lose your right to sue for the benefits). An attorney can also help identify problems with the insurance company’s initial review, and make sure those problems are noted in the record for use in the litigation. In addition, when confronted with the arguments of experienced ERISA attorneys such as McKennon Law Group PC, the insurance company or plan administrator will often reverse itself and approve the claim for benefits.

Accordingly, when appealing a claim decision under a short-term disability insurance, long-term disability insurance, life insurance or annuity plans governed by ERISA, the best thing you can do to increase your chances on appeal is to hire an experienced ERISA attorney to help you through the process.

Ten Things to Know Before You File a Claim for Long-Term Disability Insurance Benefits

1. Make Sure You Have a Complete Copy of Your Plan/Policy – The first step when making a claim for long-term disability insurance benefits is to secure a copy of your policy. If your employer provided your insurance coverage, request a full and complete copy of your policy from Human Resources. Make sure you get a complete copy of the plan/policy, not just the Summary Plan Description. If you purchased your policy directly from the insurance company, or through an insurance agent/broker, you probably already have a copy of your policy with the application attached. If you cannot locate it, contact the agent/broker and/or the insurance company to request a copy of the policy.

2. Be Aware of all Deadlines – Many insurance policies contain deadlines requiring you to submit your claim within a certain period of time. It is important to be aware of these dates so you do not inadvertently waive your rights to benefits. In fact, you should try to make your claim as soon you realize that your disability prevents you from working to make sure that you do not accidentally miss a deadline.

3. Become Familiar with Your Policy’s Definitions/Provisions – Every disability insurance policy/plan is different. Be sure to read your policy/plan so that you are familiar with its terms. This will help you figure out what information you will need to provide to the insurer to support your claim for disability insurance benefits. The policy/plan will also include the definition of “Disability” or “Total Disability” that the insurance company will use to evaluate your claim. You will want to review policy/plan provisions so that you know some of the following:

What are your total policy/plan benefits and how are they calculated?
What is the elimination period?
What are limitations on policy/plan benefits?
Are there offsets to your policy/plan benefits and if so, what are they?
What are the exclusions to coverage?

4. Request and Complete All Claim Documents – After you identify to whom you must submit your claim, you need to request and complete all of the claim documents/forms. This typically includes forms to be completed by you, your employer, and your medical health professional(s). It is very important that you promptly complete all of the documents and make sure they are submitted to the insurer. If you fail to complete all the required documents, the insurance company will likely deny your claim citing “lack of information,” regardless of the strength of your disability claim.

5. Gather Your Medical Records and Make Sure Your Medical Health Professional(s) Support Your Disability – When you decide to make a claim for disability insurance benefits, the most important documents you will submit to the insurance company are your medical records and the opinions of your medical health professional(s). The insurer will evaluate your records to determine whether it believes you are capable of performing your job duties in spite of your medical condition, diagnosis and restrictions and limitations. It is therefore important not only to make sure that you send the insurance company all of your medical records that support your claim, but also that your medical health professional(s) agrees that your condition prevents you from returning to work. If your medical health professional(s) thinks you can work is some manner, then the insurance company is very likely to follow their opinion and deny your claim. Make sure your medical health professional(s) understand your material and substantial occupational duties so they can correctly evaluate whether you can work and for how long.

6. Make Sure You Provide a Clear Explanation as to How Your Disability Prevents You From Returning to Work – Your claim for long-term disability insurance benefits depends on your being able to demonstrate that your medical condition, and associated restrictions and limitations, prevent you from performing your job duties. It is therefore important that you are able to explain to the insurance company why you can no longer work. For example, if you suffer from migraine headaches, you should explain that the headaches make it difficult for you to concentrate. Or if you have a back condition that prevents you from sitting for an extended period of time or lifting things, you must make that clear to both your doctors and the insurance company. You must give the insurance company a reason to approve your claim for benefits, and simply saying “I cannot work,” is not enough. You must be able to specifically explain why you are unable work.

7. Determine Whether You Want to, or are Required to, File For Social Security Disability Benefits, State Disability Benefits and/or Workers’ Compensation Benefits – Some policies require that you apply for Social Security Disability benefits, State Disability benefits and/or Workers’ Compensation benefits, if applicable, because they can take offsets for such benefits. You can be penalized with a reduced benefit payment if you do not comply with these provisions, so make sure to apply for these benefits if required.

8. Determine if You Have Short-Term Disability Coverage – All disability insurance policies have an “Elimination Period,” which is the time period between an injury and the receipt of benefits. In other words, it is the length of time between the beginning of an injury or illness and receiving benefit payments from an insurer. It is sometimes referred to as a “waiting” or “qualifying” period. Elimination Periods can be as long as 180 days, but if you have short-term disability insurance you should be able to receive benefits during the Elimination Period.

9. Know What Law Applies to Your Disability Claim – Which law applies to your disability claim depends on how you obtained your policy. If your employer provided your insurance coverage, it is more likely than not that your claim will be governed by a Federal law called ERISA, which stands for the Employee Retirement Income Security Act of 1974. If you purchased your policy directly from the insurance company, your claim will likely be governed by State law. If your claim is denied, your damages and potential remedies will likely be larger under state law, because you can sue the insurance company for past due and future benefits, as well as for bad faith (also known as a breach of implied covenant of good faith and fair dealing). The remedies available under ERISA are limited to past due benefits, and possibly attorneys’ fees if you prevail in your lawsuit.

Additionally, if your claim is governed by ERISA, then the plan’s language and definitions will control. However, if your claim is not governed by ERISA, but is governed by California’s or some other state’s laws, you should know this. If state law governs, you may be able to disregard the definition of total disability in your policy and use the applicable state law definition. This is especially true in California where the law is very friendly to consumers. Very often, we see insurance companies incorrectly use the definition of total disability, which can be outcome determinative to your claim. If you are not sure if your claim is governed by ERISA or state law or if you are not sure what legal definition of total disability applies to your claim, you should contact an experienced attorney.

10. Be Careful What You Post on Social Media Sites – Insurance companies have begun to check their claimant’s social media posts to see if they are acting in a way that is inconsistent with their claimed restrictions and limitations. While everyone likes to put their best foot forward on social media, if your Facebook or Twitter posts (writings or photos) conflict with your claimed restrictions and limitations, the insurance company may use your own words or photos as a basis to deny your claim. If you feel you must regularly update your Facebook or Twitter accounts, set them to private, do not accept friend/follower requests from anyone you do not know and be very careful about what you post.

California Court Limits the Enforceability of Contractual Limitation Periods Because the Insurer Failed to Properly Provide ERISA Plan Documents

In an interesting opinion concerning a dispute over long-term disability (“LTD”) insurance benefits due under an ERISA plan, a District Court held that an ERISA administrator cannot rely on a contractual limitation period to defeat an insured’s claim where it failed to provide the insured with sufficient documentation and/or notice of the existence of the limitation period. The decision in Barnett v. California Edison Co. LTD Plan, U.S. Dist. LEXIS 71345 (E.D. Cal. May 20, 2013) emphasizes that administrators of ERISA-governed policies must first discharge their fiduciary duty to fully inform the insured of existing contractual limitation periods before attempting to enforce provisions to defeat a lawsuit initiated by a plan participant.

Barnett involves a Plaintiff who was an employee of Southern California Edison and a participant in Edison’s long-term disability insurance plan (“Plan”). Significantly, the Plan contained a contractual limitation period requiring that a plan participant institute legal action no later than 180 days after a final decision is rendered on his or her appeal. The Plaintiff applied for disability benefits under the Plan and was initially approved. However, Plaintiff’s LTD benefits were terminated following an independent medical examination after the examining physician opined that he was no longer disabled under the terms of the Plan. The Plaintiff appealed the decision twice, and but the administrator upheld the original denial decision both times.

The Plaintiff then filed a lawsuit against the Plan alleging three causes of action. However, the Plaintiff’s complaint was filed after the expiration of the 180-day contractual limitation period. The parties filed cross Motions for Summary Judgment. The Plaintiff sought a declaratory judgment barring the Plan from relying on the 180-day contractual limitations period. The Plan’s opposition and counter-motion argued that the Plaintiff was time barred by the contractual limitation.

The relevant portion of the policy provides:

If your appeal is denied, in whole or in part, you may bring a civil action in federal court. However, no action may be brought . . . until you have exhausted the claim and appeal procedures in this Handbook. Further, no legal action may be brought . . . more than 180 days after the final decision has been rendered . . . on the appeal of your claims for benefits under the terms of the respective plans.

The Court first focused on the issue of the Plan’s fiduciary duty toward the Plaintiff. The Court cited to 29 U.S.C. section 1004(a)(1) and found that the Plan had a fiduciary duty under ERISA to deal with plan participants “fairly and honestly.” The Court then addressed a specific request made by the Plaintiff to the Plan, following the denial of his appeal, for all documents relevant to his claim for benefits including “the plan, with all amendments and the Summary Plan Description and all amendments.”

In response to the Plaintiff’s demand, the Plan’s contract administrator, Jacobs, sent a letter to Plaintiff stating that “enclosed you will find copies of Your Benefits Handbook for the Plan, accompanying plan change notices, and the applicable LTD trust documents. There are no . . . separate documents in relation to the LTD Plan.” However, what Jacobs sent to the Plaintiff was only a thirteen-page excerpt from a much larger Plan document which did not contain the limitation period clause that was in the larger document. As such, not only did the Plan fail to provide Plaintiff with notice of the limitation period clause, but also misrepresented the terms of the Plan by stating that the excerpt constituted the entire Plan document.

The Plan raised two arguments in support of its contention that had not breached its fiduciary duty. First, it argued that the summary Jacobs provided referenced the larger Plan document and thus Plaintiff was on notice that there was a larger Plan document. The Court found this argument to be unpersuasive because, the reference to the larger document does not overcome Jacobs’ blatant misrepresentation that the summary was the complete Plan document. Second, the Plan argued that Plaintiff had access to the complete Plan because it was available online and that a summary of the Plan was distributed to all plan participants. The Court found these arguments to be equally unpersuasive because online access does not overcome Jacobs’ misrepresentation and the fact that a summary was distributed to all plan participants is irrelevant because the summary did not contain the limitation period clause.

Based on all of the above, the Court held that the Plan breached its fiduciary duty by providing the Plaintiff with a thirteen-page summary the Plan document while representing that it was the complete document. As a result, the Court enjoined the Plan from relying on the 180-day contractual limitations period.

The Court’s decision in Barnett is significant in that it increases the burden on insurers and other ERISA administrators to fully disclose and inform insureds of contractual limitation periods and other important provisions in ERISA-governed plans before relying on them to prevent insureds from pursuing and prevailing in legal actions. Moreover, the Court in Barnett emphasized that insurers cannot excuse misrepresentations made by its agents and employees with regard to the contents of a Plan document by asserting that the information is available to the insured elsewhere.

CIGNA Forced to Re-evaluate Long-Term Disability Insurance Claims Handled Between 2008 to 2010, and Set Aside $77 Million to Pay Previously Denied Claims

Following an investigation conducted by the California Department of Insurance via a market conduct examination, as well as insurance regulators from Connecticut, Maine, Massachusetts and Pennsylvania, CIGNA and these states’ insurance regulators, reached a settlement over its improper handling of claims for long-term disability (“LTD”) insurance. This resulted in a Regulatory Settlement Agreement (“Agreement”) between CIGNA and its affiliates and these insurance regulators. The companies involved in the evaluation and settlement include CIGNA Health and Life Insurance Company (formerly known as Alta Health and Life), and Connecticut General Life Insurance Company, Life Insurance Company of North America (collectively, “CIGNA Companies”). In the examinations of CIGNA Companies, insurance department officials found that the CIGNA Companies engaged in numerous claim-handling irregularities, including not giving due consideration to the medical findings of independent physicians, discounting information provided by Social Security Disability decisions and not giving appropriate consideration to Workers’ Compensation records.

In addition to paying $500,000 penalty to the California Department of Insurance and $150,000 to reimburse the department for the cost of ongoing monitoring, the CIGNA Companies are settling aside $77 million for projected payments to policyholders potentially nation-wide whose claims were not handled properly. This money is being set aside for claims improperly handled between January 1, 2008 and December 31, 2010.

In addition to paying the fine and re-evaluating previously denied LTD claims, under the Agreement the companies are required to:

Enhance claim procedures to improve the claims handling process to benefit current and future policyholders.
Establish a remediation program in which the companies’ enhanced claim procedures will be applied to certain previously denied or adversely terminated claims.
Participate in a 24-month monitoring program, including random sampling and ongoing consultation by the five states’ insurance departments.
Undergo a re-examination upon completion of the monitoring period.
Pay fines and administrative fees totaling $1,675,000 to the five lead state states.

The “enhanced claims procedures” that the CIGNA Companies must implement include:

Procedures regarding the weight to be given to awards of Social Security Disability Income benefits;
Enhanced procedures regarding the gathering of medical information and the documentation of conclusions;
Guidelines/or Use of External Medical Resources (i.e., following guidelines when utilizing Independent Medical Examinations or Functional Capacity Evaluations and providing claims personnel and outside professionals (such as consulting physicians) with all available medical, clinical and vocational evidence, including both objective and subjective evidence of impairment);
Ongoing objectives (such as the CIGNA Companies’ claim procedures shall include focus on policies and procedures relating to medical and related evidence, as specifically described in the Agreement and clear and express notice to claimants of the information to be provided by the claimants and the information to be collected by the CIGNA Companies);
Selection of Evaluation Personnel;
Professional Certification; and
Providing Medical, Clinical, and/or Vocational Evidence.

The insurance regulators have implemented procedures to ensure that the CIGNA Companies comply with the “enhanced claims procedures” as described above.

If you had a LTD insurance clam denied by the CIGNA Companies, you may be entitled to a portion of the $77 million. It is irrelevant whether you purchased your own individual policy with your own money or if the disability insurance was provided by your employer (and is thus governed by ERISA). If your claim for disability benefits was denied by CIGNA, you should speak with an attorney as soon as possible to ensure that your claim if properly handled and that CIGNA has followed the special procedures required under the CIGNA Settlement Agreement. The McKennon Law Group PC is currently handling several CIGNA claims on behalf of claimants whose rights were violated when CIGNA’s unfair claims practices, as identified above, resulted in a denial of their disability and life insurance claims. If you would like to discuss your claim with an attorney, please contact us for a free consultation.

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