Friday, January 30, 2009

Court Blasts CIGNA LTD Benefit Termination

A federal district court judge issued a 44 page decision today that condemned CIGNA’s termination of a long term disability (“LTD”) benefit claim, which was consistent with the same type of bad faith claim decisions of CIGNA that were exposed on ABC News’ “Good Morning America.” That ABC News expose can be seen on the internet at http://abcnews.go.com/GMA/story?id=5257491&page=1. CIGNA arrogantly contended that as long as it went through the motions of supposedly considering the evidence that Plaintiff submitted its decision had to be upheld. The Court strongly disagreed for a variety of reasons.

First, the plaintiff’s medical records showed that his condition had not improved between the time that CIGNA approved and then subsequently terminated his LTD benefits. The Court criticized CIGNA’s termination “preceded by no significant change in the claimant’s physical condition”.

Second, the Court rejected CIGNA’s assertion that it could “reject the opinions of treating physicians for any or no reason at all.” To the contrary, the Court ruled that because CIGNA failed to “cite any rational justification for its decision to discredit Alfano’s treating physician evidence, this evidence is entitled to substantial weight.”

Third, the Court ruled that CIGNA “erred in discrediting the SSA decision,” especially since “it accepted the SSA decision awarding Alfano disability benefits without question when it reduced Alfano’s initial LTD benefits award by the amount of his SSD benefits.” To make matters even worse, the Court pointed out that CIGNA forces claimants to apply for SSD benefits; otherwise, CIGNA will reduce their LTD benefits by the estimated SSD benefits. The Court further chastised CIGNA’s disregarding the SSA decision because its definition of disability was basically the same as CIGNA’s; that is, the SSA specifically found that the plaintiff was unable to do his past work or any other work as well. Therefore, the Court found the SSA decision probative of the plaintiff’s claim for LTD benefits, and gave it substantial weight.

Fourth, CIGNA has a habit of intentionally misreading its functional capacity evaluation (“FCE”) reports. Rather than relying on the actual test data, CIGNA blindly accepts the conclusion of the physical therapist who performs the FCE, even when contradicted by the test data, over the opinions of treating physicians. The Court explained that “CIGNA offers no rational reason” for doing so. Therefore, the Court rejected the FCE, and all of the medical and vocational reports by CIGNA’s doctors and vocational consultants who relied on it

1 comment:

Fighting4Rights said...

CIGNA is crimainal in their policies and procedures, the ignore Board Certified Physcians reports, medical imaging results. Your claims rep, is trained by on the job training yet has the authority to over ride a Board Certified Physcian.
In my particular case, I was permanently disabled while working for the state of Arizona. As part of the benefits package, Arizona paid premiums to CIGNA Long Term Disabilty. If you accept CIGNA'S LTD you will be force(extorted)to assist to the "Nthed" degree to recover from Social Security your benfits, when if sucessfull you will pay ALL funds to CIGNA who has already been paid by the person or state in my case a premimum to provide benfits. In my case the first go around with Soc Security, the award was not enough for CIGNA, so they pushed for a earlier onset date, again you are forced to cooperate in all and I mean all aspect of the recovery. CIGNA retains a third party law firm to do their dirty work, the constantly premote that they are working for you, however, you will not see one dime, and most likely pay expenses to get to the point of hearing with the Soc Sec Admin. Judge. The law firm, who represtents CIGNA has todate been trying to recover the second award or earlier date of onset for 7 years, yes 7 years I have been scheduled, changed, scheduled venue moved, all under the guise of their doing it for you, if you refuse or do not cooperate %100 percent CIGNA will terminate your LTD benefits. Yes they are criminal. At least a person, not injured, looses a job due to economic problems or whatever has the ability to look for another form of employment, permanently disabled people don't have that luxury.
If you are thinking of buying CIGNA run away, if you are in their system already, FIGHT THEM. You have rights.
Yesterday I spoke with Mr. Delott, who was extremely helpful and it was without fee. He was more than willing to take my case but pointed me in some directions to try and get it done. I do believe this man understands the plight of the injured worker. Thank you Mr. Delott.