- Report: #1124872
Report - Rebuttal - Arbitrate
Complaint Review: CIGNA Health & Disability Insurance
CIGNA Health & Disability InsuranceCIGNA Group Ops 2000 Park Lane Dr Pittsburgh, PA, Select State/Province USA
CIGNA Group Insurance Disabiliity Management Solutions Cut off my pay at 12 weeks, leaving 6 months without disability pay during doctor restriction Pittsburgh Pennsylvania
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CIGNA is pocketing approximately $10,000 which under short term disability and long term disability would be received by me between Jan 23 and July 23 2014. They are leaving me without disability pay during this period, in which my employer says my work restrictions from the doctor cannot be accommodated. The employer will terminate me Apr 23, the doctor restriction is till July 23. During this period I also am not eligible for unemployment. Therefore, CIGNA full well know, I have no other primary income.
The origin of my situation was several attacks of ventricular tachycardia VT) on Oct 24, 2013, one of which occurred in a store where I am assistant manager, but after close. Normally it is fatal without immediate medical help. For some reason, I passed out 1 1/2 hr then came to, and survived two more attacks on the way to the ER. I was hospitalized a week. I am also a disabled vet, but VA refused to cover any of my medical expense since I hadn't used them in the preceding 24 months. Workmens Comp refused to cover, saying it was personal health, so I was put on short term disability, which changes to long term disability after 26 weeks (Apr 23). Both STD and LTD are a company benefit. CIGNA agreed for the 12 weeks that my vulnerability to episodes of VT and the healing in of the implanted cardiodefibrillator(ICD) constitute a disability. Then, all of the sudden, their definition changed on Jan 23.
CIGNA paid for the first 12 weeks during which I was covered by FMLA. The two weeks before Jan 23 they claimed to be constantly having problems getting 'information' from my VA doctor. Conveniently for CIGNA, this always seemed to happen about 3-4 days before a disability payment was due to be posted to my employer. Previous to that date I already had 3 times where the payment missed the company cutoff.
Then on Feb 4, they informed me they were not continuing disability payments after Jan 23 - more than two weeks after the deadline for the Jan 23 pay to be submitted. Their rationale? I don't have a 'disability'.
The way they figure this is that I don't have an 'abnormal heartbeat, evidence of tissue damage, physical blockage, etc.. In doing this they are COMPLETELY disregarding sec 12102 of ADA, SSI law, and motor vehicle definitions of 'disability'. All clearly state that a disability is any doctor-verified condition that causes limitation of primary life activities including work. The heal-in of the ICD is clearly a limited term disability since I will have full lifting capacity by July 23. Therefore, CIGNA is obligated as insurer to STD and LTD payments.
In denying me payment, CIGNA is pocketing approximately $6300 in short term disability benefits thru Apr 23, and $4200 in long term disability benefits which would be due to me based on the VA doctors determination of disability. The fact that the company has determined I cannot perform the duties of the position I had(which include a lot of physical movement of stock) is additional proof that my condition is a work-affecting disability.
Oh, of course they say 'you can appeal', but they don't tell you they have 90 total days to respond for each appeal. And they know if you're without money, you won't be a problem for them. I don't have $2500 for a lawyer to attack these predators on the disabled. So I am taking this to the web, vet organizations, and those responsible for regulating this kind of thing.
CIGNA is using their contrived definition of 'disability' as a pretense to deny me payment. They are doing so with full knowledge that I have no other primary income, I cannot receive unemployment while employed or disabled, I have large medical bills, and a wife with autoimmune disease (thyroid/lupus/cancer). CIGNA's final letter to me claims that the ICD heal-in limitations prescribed by my VA doctor are not a 'disability'. They cite the 'ERISA' act as an excuse, which places burden of proof on the claimant and say they just don't have 'information' from my VA doctor. My VA nurse has faxed the doctor restriction numerous times, it is right under their nose, They claim I have no heart anomalies - HELLO- I have a cable running into my heart that is still healing up, the basis of my restriction till July 23.
My case is only one more proof that the 'business ethic' at CIGNA is to profit off denying payment to legitimate claims and taking advantage of the disabled. How is this not a violation of ADA???. They will use every tactic and pretense to delay and deny payment, even for disabilities which clearly are such under federal and state laws. They have crippled my efforts to search for other work that can accommodate my disability, they have stressed my sick wife to the breaking point, they have created incredible pain and suffering in denying me any income to pay medical bills or even buy food, KNOWING I cannot get unemployement.
SCOUNDRELS is too nice a word for these people. And to Adelina M. the rep, and Chris the nurse, HOW CAN YOU SLEEP AT NIGHT with what you do to people? I don't appreciate getting circle-jerked by staff weenies in plush offices. I am a disabled vet who served his country with honor. WHO do you sorry weenies at CIGNA serve? Obviously 'honor' is a definition that the staff at CIGNA would have to look up. There is no honor among their kind. Clearly, Adelina, Chris, and their bosses at CIGNA do not have the courage to stand up to a dysfunctional corporate culture and do the right thing. They are trapped in a web of accountability for the suffering of myself and others from whom they profit by not honoring their commitment to cover disability.
To summarize, If they did this to me, how often are they doing this to others? 1. Disability denials contrary to the definitions of ADA, SSI and motor vehicle laws
2. Early cutoff of claims on disabled persons who cannot return to work, cannot get unemployment
3. Denial of payments for employer and physician validated disability
4. Delay-of-payment tactics - submit specious 'information requests' to doctors 3 to 4 days before they are supposed to transfer a payment to the employer, when a doctor's note is right under their nose.
5. Disregarding the claimant doctors judgement of disability and restrictions
This all adds up to a lot of profit of the misery of legitimately disabled claimants, including veterans.
Doesn't wrongful denial of pay on legitimate claims represent a violation of civil rights of the disabled & EEOC violation? It is financially hacksawing the disabled employee who cannot return to work, yet cannot get unemployment.
Doesn't denial of legitimate disability claims represent FRAUD on consumers?
Doesn't misuse of 'disability' definitions to cut off legit disabled claims represent a violation of ADA?
And if CIGNA is pushing off their obligations by forcing penniless claimants into SSI, is not that also FRAUD against taxpayers - shifting billions of dollars in burden to the SSI system?
IF CIGNA is a benificiary of federal funds in any manner, the feds DO have authority to audit them.
Does ANYONE think that these experienced pros at CIGNA are UNAWARE of the tactics they are using?
CIGNA profiting from mistreatment of disabled claimants AND veterans MUST STOP!!!
This report was posted on Ripoff Report on 02/19/2014 02:37 PM and is a permanent record located here: http://www.ripoffreport.com/r/CIGNA-Health-Disability-Insurance/Pittsburgh-PA-Select-StateProvince/CIGNA-Group-Insurance-Disabiliity-Management-Solutions-Cut-off-my-pay-at-12-weeks-leavin-1124872. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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