Saturday, February 2, 2013

CIGNA LTD Fraud Template

Regular followers of this blog have read about CIGNA’s protracted history of denying disability claims in bad faith. A few months ago I described how one appellate court held that, CIGNA had a "predisposition to reject the claim regardless of the facts,” which is an argument that I regularly make about CIGNA. In another post, I described how another CIGNA decision used the same unlawful tactics that were used in the Alfano case I handled. That post noted that CIGNA’s wrongful LTD termination and denials have become so rampant that ABC News’ Good Morning America did an expose on it. The latest reported CIGNA decision provides more evidence demonstrating CIGNA’s history for biased claim adjudication. 

In Deloach v. Great Atlantic & Pacific Tea Co. LTD Plan, 2013 WL 363840 (E.D.Mich. Jan. 30, 2013), CIGNA terminated long term disability (“LTD”) benefits after Gary Person of CIGNA Group Insurance denied Deloach’s final appeal. CIGNA had previously determined that Mr. Deloach was disabled by his cardiovascular impairments. Mr. Person accepted the opinion of CIGNA’s in house physician, Dr. John Mendez, who reviewed the file and concluded that there were no “significant measured physical limitations” to support the treating physician’s physical restrictions. Mendez has absolutely no cardiovascular background, and holds himself out as an occupational medicine physician, based his statement on CIGNA’s “hired gun” Dr. Sushil Sethi who did an “IME.” 

 The court noted that there was no dispute regarding Deloach’s diagnosis or symptoms, but that CIGNA claimed there was no “objective” to support the treating doctor’s limitations. The court ruled that the LTD plan did not require objective tests, and that there are no objective tests to measure symptoms. The court also found that CIGNA selectively cherry picked medical findings out of context to terminate benefits. Perhaps more importantly, the court held that there was difference in the disability definition used by the plan and Social Security, and that Mr. Deloach’s condition had not changed since Social Security approved him for disability benefits. 

CIGNA has employed the identical practice and pattern of bad faith tactics in a case that I am currently litigating in the Eastern District of New York. In that case, on behalf of Life Insurance Company of North America, doing business as CIGNA, Gary Person terminated my client’s LTD benefits based upon John Mendez’s file review. My client has neurological and orthopedic impairments, which is outside Mendez’s expertise. Mendez of course stated that there was no objective evidence to support the limitations of my clients half dozen treating physicians, and Mendez based his conclusion on CIGNA’s hired gun, who did a file review, not an IME. There also was no change in my client’s condition since Social Security found him disabled. 

A court has just ordered CIGNA to produce both Gary Person and John Mendez for depositions at the Courthouse in New York. If anyone has had a claim denied or terminated by CIGNA that involves either Person and Mendez, I would appreciate hearing from you.

No comments: