No one should be unlawfully denied their health insurance claims. Unfortunately, there are a number of insurance companies operating in the country today who have a long history of unscrupulous business practices. They are primarily concerned with maintaining their bottom line and not with providing the level of care that they legally owe their clients. Cigna is precisely one of these companies, and if you are a customer of theirs and need help appealing your claim denials, then contact Stop Health Insurance Denial today.
Bad Faith and Insurance Denials
Cigna is a health services company that is located in Connecticut. They also have an affiliate known as the Life insurance Company of North America (otherwise referred to as LINA), and together they form a conglomerate company under the banner of Cigna/LINA.
There is a legal duty for your insurance company to act in good faith when handling any dealings with you, their clients. If you feel that Cigna/LINA has failed to meet this responsibility, then you may be able to sue the company on a bad faith claim. Unfairly denying your claims, particularly disability insurance, is a way in which Cigna/LINA may have failed to uphold its legal duty to you as an insurer.
There is any number of reasons that Cigna/LINA may have used to reject your claim, including:
- You did not disclose a pre-existing medical condition.
- Your past medical examinations were not sufficient or were inadequate.
- There were problems with your documentation and/or paperwork.
- You filed a claim for a condition that was not “covered” under the policy.
- Claiming that your procedure was “elective”, and therefore not medically necessary.
These reasons can all be legitimate under the right circumstances, but too often insurance companies use them as a means to issue bad faith claim rejections. This is true of both short-term care and long-term disability benefits.
What Should I Do If My Cigna/LINA Claim Was Denied?
Like all insurance companies, Cigna/LINA has a legal obligation to do right by its customers and to provide fair and equitable coverage for all eligible customers. A common unscrupulous tactic that many insurance companies may take, including Cigna/LINA, is to unfairly deny coverage or reject claims on spurious grounds. If you have had a claim denied, there are a few steps you should take:
- Review the coverage denial - Like all insurance companies, Cigna/LINA is legally required to give you a comprehensive and detailed explanation for their denial of your claim. It is standard protocol that you received an official letter in the mail that explains precisely why your claim was denied. Save this letter and always bring it to your attorney so that they may build a case that is specific to your needs.
- Maintain effective organization - Appealing an insurance denial is an exercise in rigorous organization; a common tactic by unscrupulous insurance companies is to drown you in paperwork and red tape. These organizations have massive bureaucracies that they may wield and use against you to keep you from effectively appealing their denials. Always keep all records, documents, correspondence, or any other information related to your denial and share it with your attorney.
- Gather all the supplemental evidence - In most cases, it will be necessary that you present additional evidence to successfully overturn the bad faith denial from Cigna/LINA. At Stop Health Insurance Denial, we have an entire team of attorneys who are well versed in these cases and know how to effectively use this supplemental evidence to get your claims approved.
- Retain professional help - If you have exhausted all the possibilities within the Cigna/LINA system, you are still not out of options. Contact Stop Health Insurance Denial right away and we can get a legal team on your case immediately. They will take over and create a customized strategy for your case to effectively wield our collective knowledge on dealing with Cigna/LINA and any bad faith insurance denials you may have been a victim of.
Insurance companies are behemoths; they have so many resources at their disposal that it can feel like you are outmatched and outgunned at every juncture. However, if you retain a law firm that has the legal know-how and experience in these cases, they can help you mount an effective offense to get your claims approved and secure the medical treatment that you or your family need.
How To Hold Cigna/LINA Accountable for Their Bad Faith Claim Denials
There has been a recent seventy-seven million dollar ($77 million) settlement to cover various medical claims that Cigna/LINA has inappropriately denied in recent years. Consequently, Stop Health Insurance Denial can help you hold Cigna/LINA accountable because:
- We are familiar with the strategies and tactics used by the large insurance companies to deny claims to hard-working individuals like you.
- We have the experience of helping countless clients overturn inappropriate denials of valid claims.
- We are a top national law firm with clients all over the country.
- We have a long track record of handling bad faith individual claim disputes as well as appeals for disability insurance.
- We can customize a strategy for your case to help you get the medical coverage you need and deserve.
- We have the resources to fight the insurance company on their terms and with their own tactics.
If you believe that you Cigna/LINA issued you a bad faith denial of benefits or legitimate claim, then you are certainly not alone. Stop Health Insurance Denial has dealt with these companies before and we know how best to handle your case to get you the results you need.
All insurance companies regularly issue denials of claims and/or coverage, but both Cigna and LINA have been regularly cited by state regulators for doing so improperly and in bad faith. Furthermore, regularly delaying or devaluing a health or disability claim also counts as bad faith handling of your health insurance policy by Cigna/LINA.
The $77 Million Settlement for Bad Faith Claim Denials
Several years ago, there was a comprehensive round of investigations conducted by Maine and other states that showed that Cigna, and several of its subsidiary companies like LINA, improperly handled medical claims in a routine fashion. The investigation also claimed that Cigna/LINA regularly failed to properly handle patient information provided to them during the application process, thereby causing consistent delays and denials that were wrongful in nature.
In fact, the Insurance Department Commissioner from the state of Pennsylvania, Michael Consedine, went on record to say that the various state examinations indicated that Cigna/LINA was “lax” and failed to use ample information provided by the patient to “appropriately process disability income insurance claims”. In other words, the onus of the blame was placed squarely on the shoulders of Cigna/LINA.
The investigations also showed that consistent denial of disability insurance claims by Cigna/LINA could lead to a variety of disastrous results for its clients, including:
- The overall loss of the patient’s regular income.
- The foreclosure or loss of the patient’s home.
- The loss of the patient’s savings.
- The overall denial of other aspects of the patient’s health care.
- Total financial insolvency for the patient.
As a result of these findings, the states of Connecticut, California, Massachusetts, Maine, and Pennsylvania took legal action against Cigna/LINA and settled with the company on May 13, 2013. This agreement explicitly states that Cigna/LINA is legally required to re-evaluate any and all claims that were affected by its chronic mishandling of patients’ claims.
This agreement also set aside a specific remediation period for all claims denied from January 2008 to December 2010 in California and January 2009 to December 2010 in the four (4) other states. Cigna/LINA is also legally required to set aside seventy-seven million dollars ($77 million) to reimburse clients whose claims were unlawfully denied during those remediation periods.
The 2013 Agreement
The same five states that were involved in the seventy-seven million dollar ($77 million) settlement, Connecticut, California, Massachusetts, Maine, and Pennsylvania, also oversaw a 2009 investigation. This investigation concluded that Cigna/LINA engaged in a widespread and unscrupulous pattern of violating state and federal insurance trade practices statutes.
This investigation resulted in a final agreement, enacted in May of 2013, that imposed various stringent terms on Cigna/LINA in order for the companies to continue doing business in these five (5) states. These terms include that the companies’ compliance will be monitored by randomly selecting denied insurance claims by state regulators to ensure that all protocol is being lawfully followed.
Furthermore, the settlement also specified that Cigna/LINA was required to pay each of the five (5) states a one-hundred and fifty thousand dollar ($150,000) fee for all the operational costs of the monitoring programs to ensure total compliance with state laws. There were also additional fines that some of the states’ insurance departments levied against Cigna/LINA.
The exact conditions of this settlement agreement require that Cigna/LINA:
- Improve their claim protocols by enhancing the handling process of claims for current and future clients.
- Create a remediation program to reimburse clients whose claims were unlawfully terminated, rejected, and/or delayed.
- Take part in a twenty-four (24) month compliance program overseen by the insurance departments of the five (5) states in question; this will include a random sampling of denied claims and ongoing consultation.
- Undergo a complete re-examination and potential overhaul following the twenty-four (24) month compliance program.
- Pay administrative fees and fines for 1.675 million dollars ($1,675,000).
Although the period of the compliance program was effectively ended in 2015, clients located in these five (5) states are still protected under the terms of the 2013 agreement. If you feel that Cigna/LINA violated any one of these agreement conditions in their handling of your claim or disability case, then contact us immediately.
Agreement With the California Department of Insurance
Cigna/LINA has a long history of mistreating its clients and patients, resulting in numerous lawsuits and settlements with a variety of state agencies and regulators. The company also recently settled a lawsuit with the California Department of Insurance in relation to disability claim denials for the years of 2005, 2006, and 2007.
This lawsuit claimed that Cigna/LINA consistently denied the long-term disability claims of its clients without even reviewing the medical records. This means that the insurance company was so blinded by its pursuit of profits above client care, that they did not even meet the minimum requirements of their legal obligation to provide care to their clients.
For this, Cigna/LINA was fined six-hundred thousand dollars ($600,000) and made to re-investigate all the claims that it unlawfully denied. Furthermore, the California Department of Insurance and Cigna/LINA entered into an agreement that stipulated the following conditions:
- Cigna/LINA had to stop engaging in business practices that violated California insurance codes and statutes.
- Cigna/LINA had to invest approximately two million dollars ($2 million) to establish a claims administration in California to improve the quality of care provided to customers in the state of California.
- Cigna/LINA was required to invest money to lower the caseloads of its adjusters for customers in the state of California.
- Cigna/LINA increased expenditures for claims denial investigations and customer resources.
- Cigna/LINA was required to establish a “National Consumer Advocacy Team” in order to more effectively, efficiently, and quickly manage the appeals process for customers who have had their claims denied.
- Cigna/LINA was required to increase the staffing for all its appeals departments.
In this agreement, and the stipulations contained therein, Cigna/LINA did not formally admit to any kind of wrongdoing or malfeasance. It was, in essence, an effort on the part of the California Department of Insurance to protect residents of its state against unscrupulous business practices without drawing out a formal denunciation of the company.
Other Regulations and Investigations Leveled Against Cigna/LINA
There have been numerous investigations into the business practices of Cigna/LINA; it is consistently a beleaguered company that has faced an extensive amount of civil regulation. In fact, Cigna/LINA has a long record of violations and mismanagement of clients’ benefits.
For example, in 2016 Cigna/LINA was temporarily barred from enrolling new customers in its standalone and Medicare Advantage prescription-drug plans due to an audit from the United States Centers for Medicare and Medicaid Services (a regulatory agency also known as the CMS). The CMS stated that “widespread and systemic failures” within the company have resulted in its customers being unlawfully denied rights and coverage that they are entitled to.
Cigna/LINA has also come under fire for relying upon surveillance videos to unlawfully deny long-term disability benefits to its clients. That means that investigators for the company would gather surveillance video from clients’ places of work and then use the “evidence” on the tapes to deny disability coverage. A lawsuit in the Federal District Court of California found that these business practices were a clear violation of the Employee Retirement Income Security Act of 1974 (also known as ERISA). Under these ERISA violations, Cigna/LINA was required to re-examine these wrongful denials and, in some cases, provide financial compensation for its wrongful dealings with clients.
Changes to Cigna/LINA Corporate Policy
As a result of all these investigations, settlements, and penalties, there have been extensive changes to the overall policies of Cigna/LINA. In essence, the company has agreed to:
- Clarify, review, and/or update its procedures and policies as they relate to dismissed claims.
- Give all clients a reasonable timeframe for the deliberation of their disability and/or coverage claims.
- Overhaul the company's methodology for getting medical documentation from various clinicians.
- Partner with clinicians to provide the highest standard of care for its clients.
- Undertake reasonable efforts to obtain and identify all relevant records as they pertain to a client’s disability or coverage claim.
- Overhaul the use of Functional Capacity Exams (also known as FCEs) in the process of claims review
- Have all employees of the company undergo sensitivity training to provide better access to treatment for all clients.
These various changes have come following years upon years of regular non-compliance on the part of the Cigna/LINA group of companies.
However, Stop Health Insurance Denial has noticed that there are still consistent patterns of wrongful denials for customers. Due to these changes in corporate policy and a history of examinations and penalties, it is easier for our attorneys to build strong cases for victims of their malfeasance. If you feel you have been unfairly denied disability or insurance coverage, then contact us right away and we can develop a customized legal strategy to give you the best chance of appealing your denial.
Find an Insurance Denial Attorney Near Me
Going up against a huge company can seem like an insurmountable task; they have extensive legal teams and reams of paperwork to make you feel overwhelmed and insignificant. Our attorneys, however, know how best to navigate this maze of red tape and to take on their malfeasance and unscrupulous behavior. Do not let yourself get cheated out of the benefits that you are lawfully entitled to. Call Stop Health Insurance Denial Attorney today at 310-695-5241 and get your free consultation.