CIGNA/LINA Insurance Claim Denials

Holding Insurance Companies Accountable for Disability Policies

Did a CIGNA Group insurer deny you disability insurance between 2008 and 2010? Some say this may entitle you to a re-evaluation of your claim as part of the $77 million recent settlement by CIGNA to cover claims that the nationwide disability insurer inappropriately handled.

At DarrasLaw, we are familiar with the tactics and tendencies of large disability insurance companies. We have helped thousands of clients stand up to insurance giants CIGNA and LINA to overturn denials of valid claims. We are nationally recognized as the top disability law firm in the United States. We regularly handle bad faith individual claim disputes and group appeals involving disability insurance. Our experienced disability insurance lawyers and ERISA attorneys are committed to helping people when their insurance companies wrongful delay or deny their claims. If you believe your disability insurance carrier wrongfully delayed or denied your claim, or if you are getting the classic run-around, we can help you pursue your rightful benefits.

If you purchased disability insurance through CIGNA—or its affiliate Life Insurance Company of North America (LINA)—but encountered problems when you tried to collect on a legitimate claim, you are certainly not alone. All insurance companies deny claims, but regulators have cited CIGNA and LINA for improperly denying claims and ignoring proof of disability.

If your disability claim under a CIGNA or LINA policy was delayed, denied, or devalued, contact us for a free consultation. We handle individual bad faith disability claims and long-term disability ERISA appeals nationwide.

The $77 Million Settlement

Investigations—which were coordinated by Maine and other states arguably revealed that three Cigna subsidiaries (CIGNA) had allegedly improperly handled claims. CIGNA failed to use the information available to it when it processed disability income insurance claims. This led to unfair or wrongful delays and denials. Pennsylvania Insurance Department Commissioner Michael Consedine stated on record that, “The state examinations showed that these three Cigna companies were lax and not using available information to appropriately process disability income insurance claims.” Essentially, the investigation found that CIGNA’s claims-handling practices needed improvement.

California, Connecticut, Maine, Massachusetts, and Pennsylvania took action against CIGNA and reached an agreement on May 13, 2013. Per this agreement CIGNA is required to re-evaluate claims that were affected by its mishandling of claims. The remediation period covers claims denied in California from January 2008 through December 2010, and in the other four states from January 2009 through December 2010. CIGNA must also set aside $77 million to pay back people whose claims it wrongfully denied during this period.

According to Law360, the action was prompted by 2009 investigations that determined the Cigna companies’ violated federal and state insurance trade practices laws. Per the ultimate agreement, the participating states will monitor the companies’ compliance with the settlement terms for two years by randomly selecting denied disability insurance claims. According to the settlement terms, among other things, CIGNA had to pay each of the five states a $150,000 fee for costs incurred in the monitoring programs, along with additional fines to several of the states’ insurance departments.

A basic overview of the terms of the CIGNA’s settlement agreement, as outlined by Maine’s insurance superintendent Eric Cioppa, is found below. CIGNA must:

• Enhance their claim procedures to improve the claims handling process to benefit current and future policyholders.
• Establish a remediation program in which the companies’ enhanced claim procedures will apply to certain previously denied or adversely terminated claims
• Participate in a 24-month monitoring program conducted by the insurance departments of the five states involving random sampling and on-going consultation.
• Undergo a re-examination upon completion of the monitoring period.
• Pay fines and administrative fees totaling $1,675,000.

For more information about this settlement offer, click here.

If you think you are entitled to a part of the money that CIGNA set aside in this agreement, contact us today. Our team of experienced bad faith disability insurance lawyers and ERISA attorneys at DarrasLaw have the knowledge to look into your claims and determine whether you can recover compensation under this settlement. Don’t miss out on money to which your denial may entitle you. It is free to call or contact DarrasLaw online.

Other Major Litigation Against LINA (CIGNA)

Through its affiliate company LINA (Life Insurance Company of North America); CIGNA is one of the largest underwriters of long-term disability insurance plans in the United States. In 2016 alone, CIGNA reported a net income of $1.867 billion. LINA recently settled with the California Department of Insurance in relation to an investigation of disability claim denials in calendar years 2005, 2006 and 2007.

The lawsuit alleged that LINA systematically denied certain types of long-term disability claims, often without reviewing claimants’ medical proof. Furthermore, the suit alleged that LINA ignored information that could have reversed the adverse decisions. In the California settlement, LINA paid a penalty of $600,000 and agreed to reopen all of the claims that it might have wrongfully denied.
The California Department of Insurance examined Lina’s claims handling practice and procedures—in California—for the period starting in February 2005 and ending in June 2006. Generally, the examination aimed to determine whether the operating procedures of LINA conformed to its own contractual obligation in its policy forms—as well as to relevant California state laws.

Among other things, the examination reviewed:

• LINA guidelines, procedures, training plans and forms, etc.
• Application of these guidelines, procedures, and forms in claim files and related records
• Consumer complaints received by the department.

Before the investigation was completed, LINA and the California Department of Insurance entered a stipulation and waiver. While LINA officially denied wrongdoing, some question whether LINA would otherwise voluntarily agree to this stipulation—but for the exposure of what further investigation could have uncovered. The following offers more insights into the conditions of the stipulation:

• LINA agreed to stop engaging in any acts or practices in the business of life and disability insurance that violated California codes and laws.
• LINA invested roughly $2 million to establish a California-based claims administration office for the purpose of enhancing the quality of the administration of claims of the state’s consumers.
• LINA has invested money to lower claim caseloads in California.
• LINA increased spending for investigations and specialty claims-related resources.
• LINA has established a unit called a “National Consumer Advocacy Team” designed to ensure timely and effective responses to consumer inquiries and complaints. It also increased staffing for its appeals team.

LINA formally admitted no wrongdoing, so you are left to decide whether the terms of the stipulation and waiver result from prior improprieties. Many of the violations cited in the 2006 report against LINA—that the California Department of Insurance provided before LINA’s voluntary agreement to this stipulation and waiver—are directly remedied by its modifications.

In addition, the stipulation affects open claims and future claims—from the date of the stipulation and waiver. Moving forward, LINA agreed to:

• Review, clarify, and update, as necessary, its policies and procedures related to initial claim evaluations, ensuring that claimants are given a reasonable timeframe, including any extensions permitted under California or federal law, to submit information in support of their claims
• Expand its methods for requesting medical documentation at LINA’s expense from claimants’ treatment providers, including processing pre-payment requests, following up on outstanding record requests, and using copy service providers where necessary
• Partner with medical providers, as appropriate, to address and resolve providers’ requirements for customized authorizations or other forms relating to the release of claimant medical information
• Make reasonable efforts to identify and obtain all records relevant to its claims evaluation and termination including workers’ compensation, Social Security Disability Income, and other administrative records
• Reinforce its existing policies and procedures, or create new policies and procedures as necessary, related to the following:
  • Use of Functional Capacity Exams (FCEs) in the claims review process
  • Review of the claim file as a whole in making determinations
  • “Own occupation” evaluations
  • “Any occupation” evaluations and consideration of a claimant’s “station in life”
  • Impact of the “course and nature” of a claimant’s condition on a claim
  • Conduct new or refresher trainings related to certain awareness and new review policies
• Find this information and more in LINA’s Stipulation and Waiver, dated 08/2009

In addition to these proactive actions, LINA had to also remediate—where applicable. In other words, per the stipulation, LINA must review denied claims—from 2005 through 2007—to determine if the new standards would have changed whether those claimants received benefits. For those claims where the answer is “yes,” LINA must take appropriate remedial action, including payment of any such benefits due—including interest where applicable. If it is unclear whether a particular claimant should receive payment under the new standards, LINA must refer the claim to a team for additional investigation.

The California Department of Insurance scheduled to follow up, and LINA was required to timely and substantially comply with the terms and conditions of the stipulation and waiver. LINA must also maintain documents—electronically or by hard copy—that evidence the application of its new standards both proactively and retroactively.

Though much of these stipulations and provisions are only mandated for LINA’s (CIGNA’s) California residents, the proactive components may have broader implementation—as to avoid further corrective actions. If you are a California resident, and you feel that you are entitled to a re-evaluation of a previous denial, contact us today. Our team of seasoned disability insurance denial lawyers and ERISA attorneys at DarrasLaw have tremendous experience fighting—and beating—the billion dollar companies, like CIGNA, on behalf of aggrieved consumers who were wrongfully denied. If you are entitled to a reevaluation under LINA’s new standards, we can help! Please call or contact us DarrasLaw online.

CIGNA/LINA Disability Claim Denials: What Policyholders Need to Know

A denied CIGNA or Life Insurance Company of North America (LINA) disability claim can leave you without the income protection you counted on most. Many claimants have paid premiums, followed their doctors’ instructions, submitted medical records, and cooperated with every request—only to receive a denial letter claiming there is “insufficient evidence,” a lack of “objective findings,” or proof that they can return to work.

At DarrasLaw, we understand how devastating these decisions can be. Frank Darras and our nationally recognized disability insurance attorneys have spent decades helping disabled policyholders challenge wrongful claim denials, delayed benefits, benefit terminations, and low-value settlement tactics. Our team reviews the policy language, claim file, medical evidence, occupational demands, ERISA deadlines, and appeal requirements to build the strongest possible case for benefits.

CIGNA/LINA disability claims may involve short-term disability benefits, long-term disability benefits, employer-sponsored group coverage, individual disability policies, ERISA-governed plans, or state-law bad faith claims. The strategy for fighting back depends on the policy, the reason for denial, the administrative record, and the deadlines that apply to your claim.

Why CIGNA/LINA Disability Claims Can Be So Difficult

CIGNA and LINA disability claims are often document-heavy and deadline-driven. The insurer may request attending physician statements, medical records, functional capacity evaluations, independent medical examinations, surveillance responses, job descriptions, earnings records, and proof of ongoing disability. Even when a claimant provides substantial medical support, the insurer may argue that the records do not prove functional impairment.

That distinction matters. A diagnosis alone usually is not enough to win a disability claim. The key issue is whether your medical condition prevents you from performing the material and substantial duties of your occupation—or, depending on the policy and claim stage, any occupation for which you are reasonably suited by education, training, or experience.

Common reasons CIGNA/LINA may deny or terminate disability benefits include:

• Claiming the medical evidence does not support your restrictions and limitations
• Relying on paper reviews from doctors who never examined you
• Arguing that your condition has improved even when your symptoms remain disabling
• Using surveillance or social media activity out of context
• Misclassifying your occupation or minimizing your actual job duties
• Applying a pre-existing condition limitation
• Limiting benefits for mental nervous conditions, self-reported symptoms, or certain chronic conditions
• Terminating benefits when the definition of disability changes from “own occupation” to “any occupation”
• Claiming you failed to submit records or proof of loss on time
• Offsetting benefits based on Social Security Disability Insurance, workers’ compensation, or other income sources

CIGNA, LINA, and New York Life Group Benefit Solutions

Many policyholders are confused when they purchased or received coverage through CIGNA but later receive correspondence from New York Life Group Benefit Solutions. New York Life completed its acquisition of CIGNA’s group life, accident, and disability insurance business in 2020. As a result, many former CIGNA group disability claims are now associated with New York Life Group Benefit Solutions, while Life Insurance Company of North America remains an important name on many policies and claim documents.

This corporate history can make a disability claim more confusing for policyholders. Your denial letter, policy, summary plan description, claim forms, appeal instructions, and administrator correspondence may reference CIGNA, LINA, New York Life Group Benefit Solutions, or related entities. Before you file an appeal or lawsuit, it is critical to identify the correct insurer, plan administrator, policy terms, governing law, and appeal deadline.

ERISA Appeals for CIGNA/LINA Long-Term Disability Denials

Many CIGNA/LINA long-term disability claims are governed by the Employee Retirement Income Security Act of 1974, commonly known as ERISA. ERISA applies to many employer-sponsored disability benefit plans. If your claim is governed by ERISA, your appeal is not just a letter asking the insurer to reconsider. It may be your best and only opportunity to build the record that a federal court will later review.

That is why an ERISA appeal must be handled carefully. Once the administrative appeal process closes, you may be prevented from adding new medical opinions, vocational reports, witness statements, job evidence, or expert analysis in court. A weak or incomplete appeal can make a strong disability claim much harder to win later.

A strong CIGNA/LINA ERISA appeal may include:

• A detailed analysis of the denial letter and policy language
• Updated medical records from all treating providers
• Physician statements explaining specific restrictions and limitations
• Objective test results, imaging, labs, surgical records, or specialist reports when available
• A description of medication side effects and treatment history
• Evidence connecting symptoms to work-related limitations
• A vocational analysis of your occupation and transferable skills
• Statements from family members, coworkers, supervisors, or caregivers
• A response to any insurer medical reviews, surveillance, or vocational reports
• Evidence addressing the “own occupation” or “any occupation” definition of disability

Individual CIGNA/LINA Disability Policies and Bad Faith Claims

Not every CIGNA/LINA disability claim is governed by ERISA. Some individually purchased disability insurance policies may be governed by state insurance law. In those cases, a wrongfully denied claim may involve breach of contract, insurance bad faith, unfair claims handling, unreasonable delay, or failure to conduct a fair investigation.

Bad faith disability insurance claims require a different legal strategy than ERISA claims. Depending on the facts and applicable state law, available compensation may include unpaid policy benefits, interest, emotional distress damages, attorney’s fees, punitive damages, or other remedies. Because the available remedies and deadlines vary by policy and jurisdiction, it is important to have an experienced disability insurance attorney review your claim before you respond to the insurer.

How DarrasLaw Builds Strong CIGNA/LINA Disability Appeals

Insurance companies often focus on what is missing from a claim file. Our job is to identify those gaps before they are used against you. DarrasLaw reviews the denial letter, policy terms, claim file, medical records, job duties, financial documents, and appeal instructions to determine what evidence is needed to challenge the decision.

Our attorneys know that disability claims are not won by diagnosis alone. They are won by proving how a medical condition affects your ability to work. That may require medical evidence, vocational evidence, occupational analysis, functional testing, treatment history, medication documentation, and a clear explanation of why the insurer’s reasoning is flawed.

For more than 30 years, Frank Darras and the DarrasLaw team have fought disability insurers nationwide. With nearly $1 billion recovered for disabled policyholders, our firm has the experience, resources, and strategic insight needed to take on major insurance companies, including CIGNA, LINA, and New York Life Group Benefit Solutions.

Do Not Wait to Challenge a CIGNA/LINA Disability Denial

If your CIGNA/LINA disability claim was denied, delayed, reduced, or terminated, time matters. Your denial letter should explain the appeal deadline and the process for requesting a review. Missing that deadline can seriously damage your ability to recover benefits.

Before submitting an appeal on your own, speak with an experienced disability insurance lawyer. The evidence you provide now may determine the outcome of your claim, your appeal, and any future lawsuit. DarrasLaw can review your CIGNA/LINA denial, explain your rights, and help you take the next step toward recovering the disability benefits you deserve.

How Do I Know if My Disability Benefit Delay or Denial Is Wrongful?

Usually, there is no smoking gun; there is no grand act by the disability insurance company that will prove, that your delay or denial of disability insurance benefits is wrongful or in bad faith. Still, certain actions—when requested or performed by insurers—are signals that you may need to consult an experienced disability insurance bad faith denial lawyer. CIGNA/LINA, as well as most other big insurance companies, are known to employ tactics to delay, deny, devalue, and terminate valid disability coverage claims. These can include:

• Presenting exhaustive requests for occupational, financial or medical records while delaying the receipt of timely disability benefits
• Requiring an unreasonably lengthy in-home field interview or claims review by a CIGNA/LINA investigator before payment
• Requesting an Independent Medical Exam (IME) by an unqualified doctor or a paper review by a doctor chosen by the CIGNA/LINA with poor credentials or marginal training
• Questioning your doctor independently, without notifying you, via a mailed questionnaire or by phone in an effort to secure an admission that you are capable of some form of work

These are just some of the many bad faith tactics that insurance companies are known to employ to delay or deny legitimate disability benefits. The top disability insurance attorneys and ERISA lawyers at DarrasLaw review new disability denials daily to stay on top of all the new ways insurers attempt to line their pockets by collecting premiums but denying coverage. We can help you understand what’s happening if you have questions or doubts about your claim.

Experienced Disability Insurance Attorneys for CIGNA/LINA Disability Claims

Not every CIGNA or LINA denial is grounds for a lawsuit. Understanding what your policy categorically excludes is just as important than knowing what it covers. Your awareness of your policy’s exclusions and limitations can help you pick disability plans that work for you and avoid companies that will not cover you when you need them most.

If your legitimate, disability claim was denied, the bad faith insurance disability lawyers and ERISA attorneys at DarrasLaw can review your case and help you pursue your legal remedies.

At DarrasLaw we know all the bad faith tactics used by insurers and specific ways in which CIGNA/LINA has deprived policyholders of the benefits they deserve. We can address delays and denials, disputes or questions arising from:

• Interpretation of CIGNA or LINA policy provisions and exclusions
• Definition of “own occupation” and “any occupation” in CIGNA and LINA policies
• Independent Medical Exams (IME) by CIGNA or LINA
• Functional Capacity Evaluations (FCE) by CIGNA or LINA
• Attending physician statements requested by CIGNA or LINA
• CIGNA or LINA field interviews by adjusters/examiners
• Private investigators and surveillance by CIGNA or LINA
• Proof of employment and employment file requests by CIGNA or LINA
• Return-to-work attempts used against the insured
• Mental/nervous limitations in CIGNA or LINA policies
• CIGNA or LINA medical consulting reviewers specialty
• Late or missed premiums
• Termination of benefits by CIGNA or LINA
• Not returning policyholders’ calls or emails
• Claim sent materials were lost, destroyed or never allegedly received
• Repeated requests for duplicative “additional information” from CIGNA or LINA

How Our Disability Insurance Lawyers and ERISA Attorneys Can Help

Consultations are free. If you have questions about your policy—or need assistance with a claim that you have submitted or will submit—please contact DarrasLaw. The following are just a few of the things that we can do to assist you, where possible, in getting the outcome you desire:

• Determine whether your policy covers you only if you cannot work at all in your occupation or whether you meet the social security definition of disabled
• Make sure your occupational description and vocational information is accurate
• Ensure that all medical evidence is evaluated properly
• Identify violations of your rights under the Employee Retirement Income Security Act (ERISA) if your policy is group coverage
• Ensure that any company required doctor examinations are with physicians in the correct medical specialty
• Help you prepare your initial claim forms and proof of loss documents
• Make sure that your doctor’s notes fully describe your disability and show why you cannot work physically and mentally
• Fight for full payment of all your benefits with an appeal or a lawsuit

Meet Our Disability Attorneys

Frank N. Darras, Founding Partner
Experience: For more than 30 years, Frank N. Darras has focused exclusively on long-term disability and insurance litigation, including high-stakes disputes against Lloyd’s of London syndicates.

Track Record: He and his firm have recovered nearly $1 billion in wrongfully delayed and denied insurance benefits for policyholders nationwide.

Recognition: Named to Lawdragon’s Top 500 Lawyers in America for 18 consecutive years and listed in Best Lawyers in America since 2006, Mr. Darras is widely regarded as a leading authority on ERISA and disability insurance law.

Susan B. Grabarsky, Senior Trial Attorney
Experience: Ms. Grabarsky represents both individual policyholders and employee groups in complex disability disputes. Her prior experience as an insurance cost-containment analyst provides unique insight into how carriers evaluate and deny claims.

Approach: She leverages her understanding of insurer review tactics to strategically challenge Lloyd’s denials and push for full payment of valid benefits.

Reputation: Known for meticulous preparation and assertive advocacy, she has built a strong record confronting unfair disability practices.

Heather Gardner, Senior Associate
Experience: Heather Gardner concentrates on ERISA-governed and individual disability appeals involving national and international carriers.

Role in Litigation: Working closely with Frank Darras, she helps develop comprehensive administrative records and appellate strategies designed to withstand federal court scrutiny.

Professional Strength: She is respected for her precision in analyzing policy language and dismantling complex denial rationales.

Phillip S. Bather, Associate Attorney
Experience: Phillip S. Bather focuses on ERISA litigation and insurance bad-faith disputes, assisting clients through intake, claim development, and administrative appeals.

Case Strategy: He works to assemble compelling evidentiary records aimed at reversing unjust denials and positioning cases for successful litigation when necessary.

Client Commitment: Recognized for his responsiveness and detail-oriented advocacy, he supports claimants facing aggressive insurer resistance.

Trusted Legal Credentials

• AV Preeminent® Rating – Martindale-Hubbell
• Best Lawyers in America – Disability Law
• Lawdragon 500 Leading Plaintiff Lawyers

These distinctions reflect decades of focused experience, ethical representation, and consistent results in complex disability insurance litigation.

DarrasLaw Has Recovered Nearly $1 Billion in Wrongfully Denied Insurance Benefits

We fear no insurance company, including major insurers like CIGNA/LINA. We know how they handle claims, and we know what to do to aggressively assert your rights to hold them accountable.

Trial lawyer Frank N. Darras and his team handle a wide spectrum of long-term and short-term disability insurance claim denials, from a few thousand dollars to claims worth millions. We have an unmatched litigation track record of forcing insurers like CIGNA/LINA to fulfill their contractual obligations.

Frequently Asked Questions (FAQs)

Testimonial

Review: 5/5 – ★ ★ ★ ★ ★

“Heather, We are finally getting settled in New York, on Long Island. I want to thank you for all your dedication and hard work you and your staff did on our behalf to settle this case against CIGNA. Also I recall all the firms I called or emailed for over a month, with no firm but yours willing to take my case. I remember the excitement I felt when all the hard work I did finally, would be represented. You made my day! I especially want to thank you for foregoing the fees you incurred and generously absorbing these charges on my behalf. It will help! We greatly appreciate, and will be using that money for ourselves, not for expenses. Once again thank you for improving our lives”

– Tommy & Pat R.

DarrasLaw is the leading disability law firm in the nation. We are fully committed to our mission: to serve the disadvantaged and disabled by ensuring our clients receive what their insurance companies rightfully owe them. Our compassionate, seasoned disability insurance lawyers and ERISA attorneys have the skill and experience to take on large insurers at the negotiating table and, if necessary, in the courtroom.

Our top-rated, national disability insurance lawyers and ERISA attorneys are experienced with CIGNA insurance claim denials, and we take cases throughout the United States. Call us at 800-898-7299. We offer free consultations on all matters, including free policy analysis and claim help.

Disclaimer: Case results, outcomes, and testimonials are not guarantees of future success. Every claim is unique. This page is for informational purposes only and does not constitute legal advice. For advice specific to your circumstances, contact one of our attorneys directly.