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What Denied Claims Will Be Reviewed Under CIGNA Settlement?

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We posted about the California Insurance Commissioner announcing a settlement with CIGNA Group insurers that involved long term disability claims filed by insureds in five states last week. Insureds in California, Maine, Massachusetts, Pennsylvania and Connecticut who submitted a claim for long term disability coverage to CIGNA Health CIGNA Health and Life Insurance Company (formerly known as Alta Health and Life), Connecticut General Life Insurance Company or Life Insurance Company of North America (LINA or CIGNA-LINA) that was denied or adversely terminated may be entitled to review of their claim.

Under the terms of the settlement, the long term disability claims denied or adversely terminated during the following periods are subject to review:

  • For residents of Maine, Connecticut, Pennsylvania and Massachusetts: January 1, 2009 to December 31, 2010
  • For residents of California: January 1, 2008 to December 31, 2010

If your claim was denied based on your medical condition during these times, you should speak with a disability insurance attorney to discuss requesting a review of your case.

Under the terms of the settlement, CIGNA Group insurers agreed to improve its claims review process; previously denied long term disability claims from the applicable time period in each state will be reviewed under the new process. If it is determined that benefits should have been approved, those benefits will now be paid out by the insurer. CIGNA Group has set aside $77 million for payouts on existing claims and previous wrongfully denied longterm disability claims.

This review process is called the Remediation Program under the terms of the Settlement agreement.

Source: CIGNA-LINA Regulatory Settlement Agreement (pdf)

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