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CIGNA SLAMMED FOR ITS IMPROPER DISABILITY INSURANCE CLAIMS HANDLING PRACTICES

On May 22, 2013, it was announced that CIGNA, and several its subsidiary insurance companies - including Life Insurance Company of North America ("LINA"), Connecticut General Life Insurance Company, and Cigna Health and Life Insurance Company - entered into a Regulatory Settlement Agreement with multiple state Departments of Insurance throughout the country, including California. The Regulatory Settlement Agreement was the result of a targeted examination into CIGNA's disability insurance claims handling practices. Among other things, the Regulatory Settlement Agreement:

  • Imposes $1,675,000 in fines against CIGNA;
  • Requires it to set aside $48 million in reserve funds to pay disability claims that it had previously improperly denied and to set aside an additional $29 million in reserves to pay presently open claims;
  • Requires CIGNA to re-review the denied claims of California residents that were denied from January 1, 2008 through December 31, 2010; and
  • Requires CIGNA to implement enhanced claims handling practices that are intended to prevent the continued improper denial or termination of disability claims.

The enhanced claims handling practices CIGNA will now be required to adhere to are significant. For example, it must give significant weight to disability determinations by the Social Security Administration in most instances. Also, it must gather and fairly evaluate all relevant credible medical information bearing on its insureds' disability. Furthermore, it must now obtain independent medical examinations of insureds in response to requests by insureds, or their treating physicians, rather than simply denying claims based on the review of medical records alone. And finally, it must consider all diagnoses and impairments afflicting their insureds and their combined effect on their insureds' ability to work.