Thou Shalt Not Get Away With It...

In a recent court case against Cigna, the allegations included the following eight items that had been done to other people. In our case, they have done them all to us within the period of the most current denial and appeal. Each item as been annotated with what happened to us or what we found in the records. We are fighting them on each point.



1.    Failing to adopt and implement reasonable standards for the prompt investigation and processing of claims arising under its insurance policies;

- Jeff needed me to work with Cigna so we gave them verbal authorization, then written authorization, and finally at least one official Power of Attorney. Yet after two years, Cigna just came back with another excuse of "we cannot do anything in your name because none of Mr. Cobb's authorizations are of the right type." We asked them what the right type was and they sent us something that looked like a teenager had cranked it out on Word just before class...
- Jeff's disability is neurological in nature. We told them that, the doctors told them that yet case nurse Ratchet kept insisting on Jeff taking physical surveys, even after agreeing that it would make no difference in the case.  This "who's on first" routine that she had added 3 months of screwing around and in the end, used it against us because then "we could not show a physical disability." 

2.    Failing to represent to claimants pertinent facts or insurance policy provisions relating to a coverage at issue;
- Just about every claim manager we spoke to lied to us about what we needed in the way of a Power of Attorney. The one that didn't lie about that lied about everything else. You know who you are and so do we.
- Still will not provide the policy between Sony and Cigna
- Still will not provide us with proof of competency for anyone involved with this case even though there is ample cause for concern. What are they afraid we will find?  

3.    Unreasonably denying claims where it was aware that the information it required for potential entitlement to benefits existed but was not obtained or reviewed prior to making the denial decision;
 -A manager we will call "Misa Caller" knew that Social Security had performed a neuro-sych test, but failed to even request a copy of the test until June 2014 (test was done last quarter of 2013), because I talked to her about it. 
- Richard "Louie" DePalma took a case that Cigna said was OK for LTD, he was aware of not having enough information yet reviewed and denied the claim anyways. Willful ignorance.

4.    Failing to perform any functional testing or peer review of medical records on file;
- Cigna can produce zero evidence that this happened. From the records, Cigna used a geriatric non-practicing doctor (who couldn't find his ass with both hands and a flashlight) and was backed up by Nurse "RubberStamp" Ratchet whom we have dealt with before (she seconded Dr. MaGoo's recommendation some 6 hours before he made it; she is a slippery one).
- About the only type of functional testing Cigna has utilized to make this decision:

 5.    Failing to consult with health care professionals who have appropriate training and experience in the field of medicine involved in the medical judgment;

- Only medical professional 'consulted' was the 80-year old medical director with zero recent experience in neuromedicine. He is non-practicing and hasn't for years.
- Nurse Ratchet kept trying to force a physical questionnaire on us after being told repeatedly the problem was neurological rather than physiological. Worse, she then penalized us for it.
 
6.    Terminating claims during the “any occupation” definition of disability without performing a transferable skills analysis and labor market survey to identify alternate occupations appropriate to the claimants based on their restrictions, limitations, education, training and experience;

- Even though the policy between Cigna and Sony stipulates that "the claimant must earn 80% of wage quote", Cigna has chosen to ignore that and terminate the claim for reasons they have not explained.

7.    Failing to provide complete information in the file to the health care expert performing a medical review of the records;
- Richard Louie DePalma failed to provide Dr. Hall enough information to intelligently assess the claim. Richard did this out of either 
-- massive incompetence: rather than find the person he needed the information from, he did nothing, perhaps on the assumption Mr. Cobb was kidnapped by aliens and therefore no longer his problem:

-- willful ignorance (he knew why he could not reach Mr. Cobb; it was because he was supposed to be talking to someone else. Documents (Power of Attorneys, hand-written requests and personal statements by the claimant) in the records said so yet he used this as an excuse not to give the medical director enough information.

8.    Failing to clarify a claimant’s restrictions and limitations with the attending physician who was supporting disability.
- Rarely contacted the right doctor (so they got no answer or one that did not apply) and when they did, they cherry-picked statements. The professionals who had actually seen Mr. Cobb stated he was not to drive, sign any documents without his representative with him, etc. so basically he should not do anything without yet all Cigna got out of it was "he can walk and lift five pounds".

d

This list only represents a subset of what Cigna has done and continues to do. The law cannot stop them so it is up to us. I don't know if we will win but by God Cigna will know they have been in a fight.  What we really need is Remo Williams:

Keep the faith everyone!

Beth Cobb
Cigna War Journal at Gmail dot com.