Cigna, headquartered in Bloomfield, Connecticut, is a global health services organization and its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. CIGNA is one of the top health insurers in North America, with medical plans covering nearly 12 million people. Cigna operates in 30 countries, has approximately 40,000 employees and manages around $54 billion in assets.
CIGNA is the parent company of Life Insurance Company of North America. Life Insurance Company of North America (“LINA”) offers group life, accident, and disability insurance to employers. LINA was formed in 1956 by Insurance Company of North America (INA), a CIGNA predecessor company. LINA provides group disability insurance to many employers across Indiana including Toyota, the University of Notre Dame, State Farm, Sony Electronics, Covance and many others. Employees of these companies are provided short and long term disability benefits if they become unable to work due to injury or illness. LINA is responsible for processing the claims and making monthly benefit payments if the claimant proves that they are disabled and unable to return to their own occupation.
During the claims process, LINA will have a Nurse Case Manager review the medical records to determine whether an individual meets the definition of Disabled under the terms of the policy. If necessary, the Nurse Case Manager will escalate the review to a Cigna Medical Director who is an employee of Cigna. The Medical Director will also review the medical records and reports to determine whether the restrictions and limitations listed by the claimant’s treating physician are supported by the medical records. It is not uncommon for the Nurse Case Manager and Cigna Medical Director to disagree with the treating physician and to find that the claimant is able to return to work despite the medical evidence supporting the claim.
Once the claim is denied, Cigna will offer the claimant the right to appeal giving the claimant the opportunity to submit further support for their disability claim. It is important at this stage to provide Cigna/LINA with any and all information to support payment of the claim including all medical records, physicians’ reports and objective testing that establishes the cause of any pain or fatigue.
During the appeal process, Cigna will oftentimes hire an “independent consulting physician” to review the medical records and opine whether the claimant is disabled. This consulting physician does not examine the claimant; rather, the record reviewing physician simply reviews the medical records submitted with the claim and occasionally contacts the treating physician to discuss the claim in more detail. It is important for the treating physician to take notes of what transpired during the telephone conversation with the Cigna consulting physician to insure that an accurate depiction of the conversation exists in the medical chart.
If you have already been approved by Cigna for disability benefits, it is not uncommon for Cigna to hire a private investigator to conduct surveillance in order to obtain video evidence of any activities that you are engaged in while under investigation. Cigna may conduct repeated surveillance in an effort to obtain proof that you are functionally able to return to work.
The O’Ryan Law Firm has represented hundreds of individuals who have had disability claims with Cigna and despite medical evidence supporting the claim, Cigna either denied the claim initially or terminated the claim prematurely, before the claimant was able to return to work. The claims were either in the appeal stage or in litigation. One of these cases was Demaree v. Life Insurance Company of North America, where LINA denied Mr. Demaree’s disability benefits despite overwhelming medical evidence supporting his eligibility for benefits.
We have represented clients in Cigna claims who have suffered from Lyme disease, bipolar disorder, degenerative disc disease, failed back syndrome, cancer, fibromyalgia, Multiple Sclerosis and many other medical claims where the claim was either denied outright by Cigna or Cigna wrongfully cut-off the benefits contending that our client could return to work. If your claim has been denied by Cigna, or their subsidiary Life Insurance Company of North America, please contact the O’Ryan Law Firm to discuss you case in more detail at (855) 778-5055.