Like many large insurance companies, CIGNA has been known to employ bad faith practices to avoid paying long-term disability benefits. Misplacement of medical records or repeated requests for authorization forms are just two of the many tactics the insurer uses to deny claims. If you’re aware of the tactics CIGNA uses to deny your long-term disability benefits, that knowledge can help you prepare your claim and understand how to appeal a CIGNA denial.
When you apply for benefits, CIGNA will require you to sign forms to authorize your physician(s) to provide them with your medical records. If they do not receive authorization from your health professionals, they may deny your claim based on lack of medical information. Be sure to follow up with your physician to make sure they have submitted an authorization form to CIGNA.
CIGNA may make repeated requests asking your physician to complete statements about your ability to work or asking them to provide statements about the possibility of medical improvement. If the company feels you can perform some of your work functions, based on your physician’s statement, it is likely they will deny your claim.
It is common for insurance companies to review your disability claim after a specific period of time, such as 12 or 24 months. During this review period, CIGNA is able to conduct a new disability evaluation and may do any or all of the following tactics in order to deny you further benefits.
If you miss deadlines for submitting documentation, CIGNA may automatically deny or terminate your disability benefits.
If you receive a claim denial, the following steps can help you successfully appeal the decision.
Appeals can take months and there is a limited time in which to file an appeal, typically 180 days. Begin working on your appeal as soon as you receive a denial to ensure you do not miss the deadlines outlined for the appeals process.
CIGNA must provide you with information about the appeals process. It’s important for you to understand how CIGNA conducted their review of your case and why they denied or terminated your benefits. When you receive your file from CIGNA, look carefully at the strategies they used to deny your benefits such as
You should read and understand your specific disability policy. Find out how the policy defines partial and total disability, what benefit limits are included, and what types of disabilities are excluded from coverage.
Review all documentation you receive or request from your physician, a hospital or other treatment provider to ensure it is complete and accurate. Be sure to include the results of all tests, physician’s statements, reports from your employer, and RFC report, a description of your job and how your disability prevents you from performing your work.
A word of caution. Many insurance companies employ the services of a private detective or another investigator to put you under video surveillance to dig up any evidence that your disability claim is not legitimate. Always assume you’re under surveillance.
CIGNA may also search through social media looking for activities or situations that would disprove your disability benefits claim. Do not post information about your disability claim. Do not discuss the status of your disability case. Refrain from making negative statements about your disability policy or insurance company.
Remember: if your claim is denied, you have the right to appeal. You also have the right to file an ERISA appeal. Call us to find out more about the appeals process.
At CJ Henry Law Firm PLLC, we have seen all the tricks of the insurance trade and can make sure you protect your rights. To learn more about how to appeal a CIGNA denial, contact us today.