The main objective of having disability insurance is to act as a bulwark for unforeseen circumstances. However, even the best of intentions can be foiled when the disability insurance companies that you have a contract with doesn't play fair, as can be seen by the magnitude of lawsuits filed against them. For example, the CIGNA Group Insurance (CIGNA) was recently sued by several disgruntled Employee Benefits Plans' participants for violations of the Employee Retirement Income Security Act (ERISA) in several states across the country due to the way CIGNA handled their claims for disability benefits. Let us take a closer look at the lawsuits that was filed at the courts.
The First Case:
In Ricky E. Bass v Cigna Group Insurance and Nashville Wire Products Company, the lawsuit was filed at the District Court for the Middle District of Tennessee, Nashville Division by a Tennessee disability attorney for the plaintiff Ricky E. Bass. It was alleged in the lawsuit that CIGNA the plan insurer and Nashville Wire Products Company the policy holder, failed to pay long term disability (LTD) benefits due to the plaintiff under the terms of an Employee Benefits Plan.
The Alleged Facts of the Case
The plaintiff had worked at the Nashville Wire Products Company as a machine operator and as an employee of the Nashville Wire Products Company; he participated in the employee benefits plan in question. The insurer of the plan was CIGNA who undertook the financial risk of claims for LTD benefits as the plan guaranteed payments of disability benefits for those who fulfilled the terms of the plan.
The plaintiff's last day of work at the Nashville Wire Products Company was on August 31st 2007. He had been unable to continue working due to suffering from reflex sympathetic dystrophy (left upper extremity), status post laceration with surgeries (left upper extremity), hepatitis C, and major depressive disorder. The Social Security Administration (SSA) had also determined that the plaintiff is totally disabled due to his medical condition.
Nevertheless, despite overwhelming evidence of plaintiff's medical conditions, CIGNA had determined that the plaintiff was not disabled from his own occupation and denied the plaintiff LTD benefits. It was alleged in the lawsuit that even though the plaintiff filed several appeals, CIGNA still upheld its determination to deny the plaintiff LTD benefits.
Relief sought by the plaintiff
Having exhausted all administrative remedies, the plaintiff argued that he had no recourse left but to seek relief from the Court. The plaintiff is seeking from the Court the following relief:
- To compel CIGNA to produce their administrative record in this matter for the Court to review.
- To remand plaintiff's claim for further consideration by CIGNA to pay benefits to the plaintiff pursuant to the terms of the plan.
- To continue to paying benefits until such time as the plaintiff meets the policy provisions for discountance of benefits.
- To award costs of this suit.
- An award of prejudgment interest on all benefits that have accrued prior to the date of judgment,
- To award attorney's fees
- To award other relief which the plaintiff may be entitled.
The Second Case & Third Case:
In the case of Mary Jo Chamberlain v Life Insurance Company of North America, A Subsidiary Of Cigna Corporation & The Geico Corporation Group Disability Plan and the case of Sandra Sue v Life Insurance Company Of North America, A Subsidiary Of Cigna Corporation & IMS Health, Inc. Long Term Group Insurance Plan, the lawsuits were filed at the District Court for the District Of Maryland and the District Court for the Eastern District Of Virginia respectively by a Maryland disability attorney.
Both cases concern legal actions undertaken under ERISA to redress the actions of CIGNA's as the claims administrator and insurer of two separate employee welfare benefit plans and CIGNA's decision to deny the plaintiffs LTD benefits under the plans.
It was alleged in both lawsuits that CIGNA had made the decision to deny the plaintiffs LTD benefits:
1.Based on medical reviews not presented to the plaintiff's counsel prior to making the claims decision.
2.Without producing a new medical review prior to denying the plaintiff's claim.
It was also alleged in both cases that the Maryland disability attorney had requested CIGNA to provide the new documentations relied upon to deny the plaintiffs' their long term disability claims to which CIGNA refused to provide.
Relief Sought By Both Plaintiffs
Having exhausted all administrative appeals under the respective plans, the plaintiffs are seeking the following relief from the Court:
1.The plaintiffs request that the court reviews the denial of benefits in their cases and declares that the plaintiffs are entitled to all benefits under the policy including payment of all back benefits with interest.
2.The plaintiffs seek payment of all attorney's fees and costs associated with attempting to secure these benefits pursuant to the provisions under ERISA.
3.The plaintiffs request penalties payable in the amount of $110 per day or other amount as to be determined by the Court pursuant to provisions under ERISA as a result of CIGNA's failure to produce the documents requested.
4.Any other relief which the Court may deem just and proper.