ABC News Investigates
CIGNA’s Disability Claims Handling Practices

UPDATE: Since this story was originally posted in 2008, the insurance regulators of Maine and Massachusetts initiated targeted market conduct examinations of CIGNA’s disability claims handling practices. The concerns raised by Maine and Massachusetts prompted the insurance commissioners of Connecticut and Pennsylvania to also open market conduct examinations and for the California Insurance Commissioner to reopen his previous examination of CIGNA. In 2013, the examinations resulted in fines against the CIGNA companies, corrective actions being required in its handling of disability claims, and for CIGNA to reevaluate certain claims that were denied or terminated. Information on the CIGNA Multi-State Regulatory Settlement Agreement can be found here.


ABC News/Good Morning America‘s investigation by Chris Cuomo into CIGNA disability claim denials has uncovered some disturbing stories. In the video above, claimants describe some of the hardships they have been forced to endure due to denials of their claims or unreasonable delays in having their claims paid.

One breast cancer survivor, who eventually was paid on her claim with the assistance of a disability insurance attorney, describes her two-year ordeal with CIGNA as a “daily, eight-hour job just to fulfill the information that CIGNA was requesting.” The tactic of wearing down a disabled claimant with repeated requests for documentation that has already been provided multiple times — thereby deliberately delaying payment of the claim — is called “slow walking” by some in the industry. While CIGNA denies engaging in this practice, many claimants who are already emotionally and physically vulnerable due to their disability will eventually quit pursuing benefits to which they are entitled in this battle of attrition that is widespread in the disability insurance industry. In this situation, it is often necessary for a claimant to retain the services of an attorney, not only to take on legal issues with the insurance company but also to shoulder the burden of the excessive and repetitive requests for documentation.

Other claimants in Chris Cuomo’s GMA piece describe (a) three years of fighting CIGNA for their benefits, all the while sinking deeply into debt and losing everything; (b) being caught between a rock and a hard place when told by an employer that he could not return to work due to his disability, but simultaneously having CIGNA deny disability benefits; (c) purchasing insurance to protect herself and her family, only to have her business destroyed, savings depleted and fighting to keep her family home when benefits were denied or delayed.

Another of the claimants profiled, Ursula Guidry, a young wife and mother with advanced breast cancer, initially had her benefits paid by CIGNA, but after awhile, they terminated her benefits and told her she could return to work full-time. Eventually CIGNA settled the claim with her. She passed away three months later. As her husband says, it is tragic that her last year on earth was spent being in a panic over financial issues and fighting an unethical insurance company instead of enjoying as much time as possible with her husband and children.

CIGNA did not respond to GMA re any of the specific claimants profiled, but their Chief Medical Officer stated they pay 90% of disability claims filed and that the majority of their customers are satisfied.

Disability Insurer MassMutual Opens West Coast Center in Phoenix, Arizona

Disability insurer Massachusetts Mutual Life Insurance Company aka MassMutual Financial Group has for the first time in its 162-year history opened a West Coast business center. The new 60,000 sq. ft. center is located on Black Canyon Highway near the I-17 and Peoria Avenue in Phoenix, Arizona and will employ as many as 400 people. Arizona Governor Jan Brewer and Phoenix Mayor Greg Stanton were among those on hand for the ribbon-cutting ceremony of the facility on October 16, 2013.

MassMutual CEO Roger Crandall told the Arizona Republic that the new Phoenix center will primarily serve customers and policyholders in the Western U.S., allowing for faster expansion and also mitigating operational risks to the company through diversification of the location of its resources and staff. During Superstorm Sandy, we blogged about the temporary shutdown of many of the disability insurance companies located on the East Coast, including MassMutual, Unum Group/UnumProvident, The Hartford, New York Life, and Berkshire Life/Guardian Life.  With locations now in Arizona as well as Massachusetts, the company may be able to avoid a situation where its call center and other operations, such as issuance of disability benefit checks, are suspended due to a natural disaster.

MassMutual employs approximately 6,700 persons nationwide, including nearly 3,500 at its Massachusetts headquarters, which is currently in the midst of a major renovation. Roughly 25 employees have been transferred from MassMutual’s headquarters to the Phoenix facility and an additional 70+ employees, who were a part of The Hartford’s Retirement Plans business prior to its $400 million acquisition by MassMutual in September 2012, will become a part of MassMutual’s Phoenix staff. To round out its staff, MassMutual has announced plans to hire an additional 200-250 employees in the Phoenix, Arizona area.

According to the Arizona Republic, MassMutual has approximately 25,000 clients in Arizona and parts of New Mexico holding roughly $4 billion dollars in insurance coverage. While we are hopeful that MassMutual’s Phoenix facility will bring improvements to MassMutual’s disability insurance claims service, we would also advise disability claimants that having an additional 400 MassMutual local employees could also mean increased and potentially intrusive surveillance.

Guardian Life Insurance Offers Student Loan Protection Program

Guardian Life Insurance Company of America, parent company of Berkshire Life Insurance Company of America, recently launched a new program offering medical and dental professionals insurance for student loans in the event of total disability. This program, which can pay up to $2,000 per month in student loan payments is available to those with advanced degrees – including those in the dental and medical industries – and to new and future practitioners for whom this kind of protection can seem quite appealing. Understanding that most graduates will begin practicing with an increasingly heavy debt load, Guardian represented the program as a simple preventative solution – but will this “win-win” policy be there when you need it?

Statistically speaking, 1 in 4 people will suffer a long-term disability during his or her career, and claimants are responsible for proving disability prior to receiving benefits. Because insurance companies are notorious for employing a number of tactics to “disprove” a disability and avoid paying claims (including subjecting claimants to “independent” medical exams, conducting video surveillance, and otherwise causing undue delays), it is critical that you understand your policy before you buy. As Guardian Life Insurance states, only those who are deemed totally disabled will benefit from this new student loan insurance policy.  We expect that claims under these policies will be highly scrutinized, just as they would be with a traditional disability insurance claim. Those considering purchasing disability insurance or filing a disability claim should consult with an attorney to ensure they are prepared with the best possible policy in the event of a disability.

Disability Insurance Q&A:
How Should Doctors Approach Their Treating Physicians About a Disability Claim?

Question:  How should doctors approach their treating physicians about a disability claim?

Answer:  Your treating physician’s support can often be critical to getting your claim approved.  A hurried, uninterested physician may not have time to devote to your claim.  In addition, fully discussing your condition with a professional, compassionate treating physician will help ensure supportive medical records.  When to discuss your potential claim with a physician is an important timing issue.  Also, when the time comes to speak to the treating physician about the claim, a disabled dentist or doctor should ensure that the treating physician understands the definition of “disability” under the insurance policy, so that he or she can accurately opine as to the inability of the doctor or dentist to work.

Some of our previous blog posts on this important issue are available here and here.

Comitz | Beethe To Be Exhibitor at the Arizona Society of Anesthesiologists Scientific Meeting in Scottsdale

Disability attorneys from the law firm of Comitz | Beethe will be available to speak with anesthesiologists attending the 39th Annual Scientific Meeting of the Arizona Society of Anesthesiologists this Friday and Saturday at the Scottsdale Resort and Conference Center.  If you have questions regarding your disability insurance policy or filing a disability claim, please feel free to stop by our exhibitor table for informative materials and/or to talk with one of the attorneys at our booth.

President Obama Proclaims Today “International Day of Persons with Disabilities 2012”

A PROCLAMATION

Americans have always understood that each of us is entitled to a set of fundamental freedoms and protections under the law, and that when everyone gets a fair shot at opportunity, all of us do better. For more than two decades, our country has upheld those basic promises for persons with disabilities through the Americans with Disabilities Act — a sweeping civil rights bill that moved our Nation forward in the journey to equality for all. And from making health care more affordable to ensuring new technologies are accessible, we have continued to build on that progress, guided by the belief that equal access and equal opportunity are common principles that unite us as one Nation.

On the 20th International Day of Persons with Disabilities, we reaffirm that the struggle to ensure the rights of every person does not end at our borders, but extends to every country and every community. It continues for the woman who is at greater risk of abuse because of a disability and for the child who is denied the chance to get an education because of the way he was born. It goes on for the 1 billion people with disabilities worldwide who all too often cannot attend school, find work, access medical care, or receive fair treatment. These injustices are an affront to our shared humanity — which is why the United States has joined 153 other countries around the world in signing the Convention on the Rights of Persons with Disabilities, which calls on all nations to establish protections and liberties like those afforded under the Americans with Disabilities Act. While Americans with disabilities already enjoy these rights at home, they frequently face barriers when they travel, conduct business, study, or reside overseas. Ratifying the Convention in the Senate would reaffirm America’s position as the global leader on disability rights and better position us to encourage progress toward inclusion, equal opportunity, full participation, independent living, and economic self-sufficiency for persons with disabilities worldwide.

We have come far in the long march to achieve equal opportunity for all. But even as we partner with countries across the globe in affirming universal human rights, we know our work will not be finished until the inherent dignity and worth of all persons with disabilities is guaranteed. Today, let us renew our commitment to meeting that challenge here in the United States, and let us redouble our efforts to build new paths to participation, empowerment, and progress around the world.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim December 3, 2012, as International Day of Persons with Disabilities. I call on all Americans to observe this day with appropriate ceremonies, activities, and programs.

IN WITNESS WHEREOF, I have hereunto set my hand this third day of December, in the year of our Lord two thousand twelve, and of the Independence of the United States of America the two hundred and thirty-seventh.

 BARACK OBAMA

USDOJ Intervenes in Lawsuit re Discrimination Against Persons with Disabilities in Administering Law School Admissions Test

Per the order of a federal judge, the U.S. Department of Justice has intervened in the lawsuit The Department of Fair Employment and Housing v. LSAC Inc., et al.  The case was previously a state level class action suit on behalf of law school admission test takers in California, but the involvement of the Justice Department expands the lawsuit nationwide.

The lawsuit alleges that the Law School Admissions Council has discriminated against test takers with disabilities by failing to provide testing accommodations and by “flagging” test scores obtained by those disabled test-takers who were provided certain testing accommodations.  The complaint alleges that flagging the scores of the test-takers with disabilities is a violation of the Americans with Disabilities Act.

LSAC’s discriminatory policies in the administration of the Law School Admissions Test adversely impact people with disabilities nationwide.  This is a systemic problem with serious consequences that echo throughout such individuals’ academic and employment careers, and it needs to be addressed as such.  The Justice Department’s full participation in this case is an important step towards ending a long cycle of disability discrimination in standardized testing.

Thomas E. Perez, Assistant Attorney General for the Civil Rights Division

The Justice Department’s Press Release further explains:

Title III of the ADA prohibits discrimination on the basis of disability by public accommodations and by entities that offer examinations or courses related to applications, licensing, certification, or credentialing for secondary or postsecondary education, professional, or trade purposes.  The ADA mandates that testing entities administer examinations in an accessible manner. This requires testing entities to administer examinations, such as the Law School Admissions Test, so as to best ensure that, when the examination is administered to a person with a disability, the examination results accurately reflect his or her aptitude or achievement level, or whatever other fact the examination purports to measure, rather than the individual’s disability.

Ideas for Persons with Disabilities for Using
Assistive Devices in Vehicles

We have blogged previously about the NHTSA’s recommendations for adapting a motor vehicle with wheelchair ramps and similar equipment for person with disabilities.  For some people with disabilities, though, while a wheelchair ramp is not necessary, assistance is needed for routine tasks such as getting in and out of a vehicle, reaching the pedals and handling the keys.  The American Auto Club has information on several simple, easy-to-install devices, including:

  • Key Extender – For those with limited hand mobility or arthritis, key extenders offer more leverage for turning keys in the door and ignition.
  • Panoramic Rearview and Safety Mirrors – For drivers with limited mobility in their neck, these mirrors can assist with seeing in the “blind spot.”
  • Pedal Extenders – If a disability results in not being able to reach the pedals at a safe enough distance both for maintaining control and for safe deployment of airbags, pedal extenders can provide an extra 1″ to 4″.  These devices should always be installed in a vehicle by a professional.
  • Leverage Devices – For persons whose disability affects their core strength and balance, a stainless steel leverage device provides a secure platform for getting in and out of the car and can support up to 350 lbs.  These devices (pictured above) lock securely into position utilizing the vehicle’s U-type striker plate where the door latches.
  • Leg Lift Straps – For those with limited strength in the lower extremities, these bands, which are typically wrapped around the shoe, allow the upper body to do the work of lifting and lowering legs in and out of the car.

AAA, in conjunction with the American Occupational Therapy Association and the American Society on Aging, also has an educational program called “CarFit” designed to help drivers find out how well they fit into their personal vehicle.  Further information on this program is available here.

Disability Advocates Demand Closed-Captioning

A recent decision by a U.S. district court in Boston could potentially require Netflix to provide closed-captioning for the deaf, says Bob Egelko, writer for the San Francisco Chronicle.  The district court held that the Americans with Disabilities Act (ADA) prohibits discrimination in any venue, including the Internet.  This ruling competes with an opinion issued by the Ninth Circuit Court of Appeals in San Francisco, which held that the ADA only requires accommodations for people with disabilities in physical structures, such as stores, banks, churches, courthouses, etc.

The district court did not rule on the substantive factual issues, but merely set the stage for the parties to argue.  Now, those representing the disabled must prepare to demonstrate how failing to provide closed-captioning on Internet videos constitutes discrimination under the ADA.  Despite carrying the burden of proof, disability advocates should have a persuasive argument, especially in light of the fact that federal law already requires closed-captioning on television and some Internet videos.

Considering that some circuits, like the Ninth Circuit, have attempted to place physical limits on the scope of the ADA, the disability attorneys may be fighting an uphill battle if Netflix appeals the ruling.  Nevertheless, Arlene Mayerson, the disability lawyer representing the plaintiffs remains optimistic.  She says in the article, “By recognizing that websites are covered by the ADA, the court has ensured that the ADA stays relevant as much of our society moves from Main Street to the Internet.”

Click here to read the full article on the San Francisco Chronicle’s website.

Private Investigator Surveillance Methods and Terms

Private investigators use a variety of tactics to produce evidence that may be used to deny your disability insurance claim.  Below is a list of different private investigator surveillance methods and terms.  

Disability Surveillance – refers to the monitoring, recording and documenting of activities or behavior of another.  In the disability context, this surveillance is called sub rosa surveillance.  Sub rosa, a Latin phrase which translated means “under the rose,” denotes the secretive and clandestine nature of private investigator actions.

Disability Stake outs – according to Shannon Detective Service, Inc.—a private investigation company whose client list includes Arizona Counties Insurance Pool, CNA Commercial Insurance, Danielson Insurance, Farmers Insurance, Federated Mutual Insurance Company, Hartford Insurance, Insurance Company of the West, Liberty Mutual Insurance, Nationwide Insurance, Progressive Insurance, Seabright Insurance Company, Sedgwick Claims Service, Travelers Insurance and Westfield Insurance—this is a stationary surveillance method by which a private investigator documents and records a claimant’s activities.  The hallmark feature of a stake out is that the private investigator does not move or follow the disabled claimant.  In a typical stake out operation the private investigator may station in front of your home or office and record you as you come and go.  The goal of the stake out is to produce evidence that will enable the insurance company to deny your disability insurance claim.  An ABC News story shows how an insurance company successfully denied a doctor’s disability claim with evidence produced during a stake out.

Disability Pretexting – the Federal Trade Commission (FTC) defines pretexting as “the practice of getting your personal information under false pretenses.”  Private investigators are engaging in illegal conduct when they use pretexting to obtain your personal information from a financial institution.  See 15 U.S.C. § 6801, et seq.

Here’s an example of how this works: someone pretends to be you and calls your bank.  The person claims to have forgotten your checkbook, account number, social security number or other sensitive information.  He then tries to get this information from the bank.  Such conduct constitutes pretexting and violates federal law.  Id.

Although private investigators claim to use only “appropriate” pretexting methods, methods which are not illegal per se, these are the same techniques which are used to facilitate identity theft and consumer fraud.  Check out the FTC website for more information about pretexting and how you can protect yourself.

Disability Tracking Devices and GPS – this area of the law is still evolving.  In a recent Supreme Court case, United States v. Jones, the Court held that attaching a GPS device to a vehicle constitutes a “search” under the Fourth Amendment; therefore, law enforcement officials need a warrant before installing the device.  132 S. Ct. 945, 949 (2012).  Although the Court did not address the attachment of GPS devices in the private investigation context, its decision largely turned on the physical trespass involved in attaching a GPS device to another person’s vehicle.  Id.  The Court stated:

It is important to be clear about what occurred in this case: The Government physically occupied private property for the purpose of obtaining information. We have no doubt that such a physical intrusion would have been considered a “search” within the meaning of the Fourth Amendment when it was adopted.

Id.  Therefore, this ruling may be used to argue against private investigator installations of GPS devices since such installation would also constitute a physical trespass.  Private investigation companies, such as Shannon Detective Services, Inc. (SDS), are now looking how to bypass the physical trespass issue altogether through implementation of other technologies that do not require physical attachment.  Here are two examples of other technologies cited from the SDS website:

  • Disability stingrays (a device that can triangulate a cell phone signal to locate a user) will become popular in the future as a way to skirt around the new GPS laws for law enforcement.
  • Disability ping of cell phones (by accessing a user’s cell phone GPS chip) will also fill the gap created by GPS legislation since the FCC has mandated GPS chips to  be installed in all new cell phones by 2018.

Driving with Disabilities and Vehicle Modifications

Many people with disabilities find that driving enables them to keep their independence.  The ability to drive means more opportunities for employment and participation in the community.  Unfortunately, in order for drivers with disabilities to stay behind the wheel post-injury, vehicle modifications are often needed.  Even though there is more opportunity for vehicle modifications today, the process can still be cumbersome, expensive and time-consuming.

In order to assist disabled persons with their vehicle modifications, the National Highway Traffic Safety Administration (NHTSA) has published an online brochure: Adapting Motor Vehicles For People With Disabilities.  The publication guides disabled persons through the decision-making process and offers cost-saving tips along the way.

Disability insurance attorneys at Comitz | Beethe understand that getting the insurance company to fulfill its obligation and pay your disability insurance benefits is only one step toward your independence.  If you are facing a disability or simply want more information regarding vehicle modifications for disabled persons, this brochure can be a helpful source of information.


Your Most Valuable Financial Asset

What is your most valuable financial asset?  According to Chicago Tribune columnist, Gregory Karp, for most people “the answer isn’t in their golden eggs, but in the goose that laid them.”  That is, their most valuable financial asset is not their car, house or retirement account, but their ability to make money.

When you suffer from long-term or short-term disability, you will likely be unable to continue working and, therefore, will lose your most valuable financial asset – your ability to earn money.  For many Americans without disability insurance, this financial blow can be devastating.

For this reason, in his article entitled Disability Insurance Primer, Karp stresses the importance of long-term disability insurance and provides a basic overview of what disability insurance is, what it is not, and how to find an appropriate plan.  The article is a good source for those seeking disability insurance or looking to change their current disability benefits plan.

Ed Comitz, disability insurance attorney in the greater Phoenix area, also provides answers to frequently asked disability insurance questions.  For example, in his blog post, Disability Insurance Policies: Which type do you own?, Mr. Comitz describes fundamental differences between individual, group and employer-sponsored disability insurance policies.  In another post, How to Get a Copy of Your Disability Insurance Policy, Mr. Comitz explains the process of obtaining a copy of your policy from the insurance company.  Finally, in How Specific is Your “Own Occupation”?, Mr. Comitz provides understanding about key terms within your policy and how insurers may try to classify these terms in a way to deny your disability insurance claim.

May 2012 is Disability Insurance Awareness Month

It is once again Disability Insurance Awareness Month, and while the insurance companies may like to celebrate by encouraging people to purchase disability insurance, we’d like to take this opportunity to repeat some information from one of our previous blog posts regarding what your disability insurer can and can’t legally do in Arizona if you file a claim.

What your disability insurance company can do

  1. Audit your billing records and tax returns
  2. Review your medical files
  3. Use a private investigator to conduct photographic and video surveillance
  4. Look at your public Facebook profile and photos
  5. Follow your tweets on Twitter
  6. Order an Independent Medical Exam
  7. Have their doctor opine about your disability
  8. Ask for a Functional Capacity Evaluation
  9. Contact your treating physician
  10. Schedule in-person interviews with you
  11. Interview your friends, family, co-workers and employees
  12. Demand precise quantifications of how you spent your time in every professional activity pre- and post-disability
  13. Pay your claim under a reservation of rights

What the disability insurance company cannot do

  1. Impose requirements on you that are not contained in your insurance policy
  2. Attempt to influence the opinions of independent medical examiners
  3. Misrepresent policy provisions
  4. Conduct abusive interviews
  5. Unfairly delay a decision on your claim
  6. Fail to conduct a timely, adequate investigation of your disability claim
  7. Destroy key documents
  8. Lie about actions taken on a claim
  9. Place their financial interests ahead of your contractual rights
  10. Force you to litigate by offering an unreasonably low lump-sum buyout

When it comes to claims investigation, disability insurance companies sometimes skirt the limits of what they can legally do. If you believe your insurance carrier might be acting in bad faith, contact an attorney to protect your disability benefits.

Unum Plays Semantic Games in Denying Benefits for a “Heart Attack”

We have previously blogged that even Unum’s U.K. CEO agrees that Unum’s policies contain confusing language.   Recently, Unum took advantage of its unclear disability policy language — in this case, a policy containing the layman’s term “heart attack” — to deny benefits to the widower of a policyholder who had died, in medical terms, of “atheroscopic coronary artery disease.”

Annette Frie’s disability insurance policy from Unum stated that a $30,000.00 benefit would be paid to her spouse if she were to die from a “heart attack.”  However, because “heart attack” is not a medical term likely to be used on a death certificate, her husband Jim Frie suspects Unum deliberately used that term on its policy in order to deny claims by splitting semantic hairs.

When Mr. Frie submitted his claim, Unum sent him a letter offering its condolences but denying the claim on the basis that it “didn’t meet the definition of the specified illness covered by the policy.”  The medical examiner who had signed Mrs. Frie’s death certificate then sent two letters to Unum explaining that Mrs. Frie’s coronary artery disease had caused the heart attack.  In response, Unum denied the claim two more times.

The Minnesota State Commerce Department subsequently opened an investigation, but when Mr. Frie became impatient with the pace of the state’s investigation, he contacted FOX-9 investigators.  Within 24 hours of being contacted by the news station about their investigation to expose this “fist-pounding outrage,” Unum called Mr. Frie with the news that the decision had been made to pay the claim.

Even commonly-used words and phrases can take on unexpected meanings within the context of a disability insurance policy, so it is important to consult an experienced disability insurance attorney to interpret the policy language when filing a claim.

 

CDC Adds State Level Disability Site

The Centers for Disease Control and Prevention (CDC) recently created a public online database containing state-by-state, disability-specific information.  Named the “Disability and Health Data System,” the CDC says that the database can help individuals “better identify health and wellness opportunities for people with disabilities by allowing users to compare over 70 different health measures, as well as data on psychological distress and disability-associated health care expenditures.”  For instance, users can access an interactive map with tables showing how often arthritis causes a work limitation for adults in each state.

If you are facing a disability or simply want more information about disabling conditions, the database can be a helpful source of information.