California Disability Insurance and ERISA Claim Attorneys Fight CIGNA/LINA Claim Denials
At McKennon Law Group PC, we aggressively pursue your right to receive benefits from life and disability insurers like CIGNA Corporation and its companies, including Connecticut General Life Insurance Company, CIGNA Health and Life Insurance Company and Life Insurance Company of North America, also known as “LINA,” and several others (collectively, “CIGNA”). You can trust in us to handle your wrongfully denied long-term and life insurance claims because we have significant experience handling disability and life insurance claims and litigation against insurers like CIGNA. Several of McKennon Law Group PC’s attorneys, including its founder, Robert J. McKennon, previously represented insurance companies, including CIGNA’s parent company New York Life Insurance Company (New York Life), which is part of the reason why we know disability and life insurance claims and claims litigation better than anyone.
CIGNA is a global insurance company that provides health, life, disability and other forms of insurance. Several CIGNA companies offer specific types of insurance coverage to specific markets. For example, CIGNA Health and Life Insurance Company provides individual and family medical and dental insurance plans, whereas CIGNA HealthCare of Arizona, Inc. offers individual HMO plans in only Arizona. CIGNA Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates insure or administer group health insurance or health benefits plans. Connecticut General Life Insurance Company also insures group universal life insurance plans. Other than group universal life insurance, LINA insures or administers other forms of accident, critical illness and disability plans in all states except New York.
New York Life Acquired CIGNA Group Disability and Life Insurance Business
New York Life, America’s largest mutual life insurer, and CIGNA announced on December 18, 2019 that they entered into a definitive agreement, whereby New York Life acquired CIGNA’s U.S. group disability and life insurance business for $6.3 billion. New York Life intends to operate the business as a standalone entity.
In general and in our experience, New York Life has a notably favorable reputation for paying claims and is one of the best and largest mutual life insurance companies in the world. However, this is not the case with CIGNA, who in our experience is one of the worst insurers when it comes to disability insurance and life insurance denials of claims. Founded in 1845, New York Life has insured numerous lives over the years and both New York Life and its subsidiaries provide insurance to countless individuals. New York Life offers a wide range of insurance products, including term life insurance, whole life insurance and long-term care insurance. New York Life also provides group membership products that include life, disability and supplemental health benefits.
CIGNA’s Agreement to Improve Disability Claims Handling Practices in California
When it comes to disability claims handling practices, CIGNA does not have a good track record in California. In 2013, CIGNA, because of its poor claims handling practices, agreed to pay up to $77 million in order to settle disputes regarding its claims handling practices for long-term disability (“LTD”) insurance and entered into an agreement to revise its claims handling practices (the “Agreement”). CIGNA settled the dispute with five states, including California. As a result of the insurance regulators’ investigation into CIGNA, department officials found numerous improper claims handling practices, including not properly valuing independent physician opinions, ignoring disability determinations by the Social Security Administration (“SSA”) and failing to give proper weight to Workers’ Compensation records. The states’ departments of insurance also assessed $1.68 million in fines and administrative fees against CIGNA. The California Department of Insurance levied a $500,000 penalty for the conduct and another $150,000 in reimbursement for the costs of the investigation, including ongoing monitoring of CIGNA’s LTD claims handling practices in the future.
Under the terms of the Agreement, insurance regulators required CIGNA to review and revise LTD claims procedures. That review included reevaluating previously denied LTD claims for a period from January 1, 2008 to December 31, 2010. Further, the Agreement required CIGNA and its companies to enhance claims procedures, establish a remediation program for previously denied claims, participate in a twenty-four-month monitoring program, undergo a reexamination at the end of the monitoring period and (as stated above) pay a significant amount in fines.
As to revised claims procedures, CIGNA and its companies now must implement additional procedures to improve claims handling practices. The insurance regulators have also implemented procedures to ensure CIGNA’s future compliance. The Agreement specifically outlines the following “enhanced” claims handling procedures:
- give proper weight to SSA awards of Social Security Disability Income benefits;
- enhance procedures regarding the gathering of medical information;
- use guidelines for functional capacity evaluations or independent medical evaluations from consulting physicians;
- ensure that all reviews by consulting physicians or other medical professionals include all the available evidence (including subjective and objective evidence of impairment);
- refocus ongoing objectives for claims handling procedures to reflect clear and express notice to claimants of information to be provided and collected;
- select evaluation personnel;
- require professional certification; and
- provide medical, clinical and/or vocational evidence.
How does CIGNA Deny Life and Disability Insurance Claims?
CIGNA denies claims for a variety of reasons, including the following:
- CIGNA asserts that there is insufficient evidence to support the life or disability claim
- CIGNA asserts the claimant did not provide adequate medical support for the life or disability claim
- CIGNA asserts the claimant did not provide documentation or proof of loss evidence in a timely manner
- CIGNA asserts the condition which is the subject of the claim is a pre-existing condition
- CIGNA asserts the insurance application contained materially false information, and thus the policy can be rescinded
- CIGNA asserts surveillance of the claimant suggests that the claimant is not totally disabled
- CIGNA asserts the claimant’s policy has lapsed for failure to pay premiums
- CIGNA asserts an exclusion in the life or disability policy precludes coverage for the claim
What Should Disability or Life Insurance Claimants Look for When CIGNA Denies a Claim?
- CIGNA improperly investigating the claim
- CIGNA improperly obtaining opinions from unqualified persons/supposed experts
- CIGNA improperly misreading or misinterpreting medical records
- CIGNA improperly hiring and using biased “independent” medical reviewers and examiners
- CIGNA improperly denying a claim without any medical examination
- CIGNA improperly refusing to acknowledge subjective disabling conditions such as mental disorders, autoimmune disorders, fibromyalgia and chronic fatigue syndrome because there is no objective evidence of the condition
- CIGNA improperly asserting a pre-existing condition
- CIGNA improperly attempting to rescind the policy
- CIGNA improperly denying a claim with the intent to wear the claimant down to a lower settlement
- CIGNA improperly over-relying on surveillance evidence to conclude a claimant can work
- CIGNA improperly over-relying on social media evidence to conclude a claimant can work
- CIGNA improperly failing to have a meaningful dialogue with the claimant
- CIGNA improperly failing to use findings by the Social Security Administration to support a disability claim
If you feel you have a wrongfully denied claim for disability, life or other insurance involving CIGNA or any of its companies, the McKennon Law Group PC will fight for your benefits.
Having an aggressive and experienced disability, health and life insurance attorney is the most crucial decision you can make for the success of your insurance claim. If your claim for health, life, accidental death or dismemberment, short-term disability or long-term disability insurance has been wrongfully denied or suddenly terminated, fill out a free consultation form or call (949) 387-9595 to schedule a free consultation with the attorneys of the McKennon Law Group PC, several of whom previously represented insurance companies and are exceptionally experienced in handling ERISA and non-ERISA, bad faith insurance claims.