CONSUMER FORUM

Maine to benefit from disability claims settlement

Posted May 26, 2013, at 6:48 p.m.

Working Mainers whose disability insurance coverage is provided by one of three companies will likely be treated differently if they file claims in the future.

Maine’s Superintendent of Insurance, Eric Cioppa, announced last week that Maine is one of five states that settled a dispute with Life Insurance Company of North America (LINA), Connecticut General Life Insurance Co. and Cigna Health and Life Insurance Co. (formerly known as Alta Health and Life). In some cases, those companies will be taking a second look at claims they had previously denied.

Cioppa said Maine and the four other states (California, Connecticut, Massachusetts and Pennsylvania) all took close looks at the three Cigna companies and found that “they were not using available information to appropriately process disability income insurance claims.” While the companies admitted no wrongdoing by entering into the negotiated settlement, they did agree to change the way they decide whether to approve claims. (Some disability attorneys have alleged that the companies deny benefits without examining a claimant’s physical condition and that the companies use unauthorized video surveillance to show that claimants should be able to go back to work.)

As part of the multistate agreement, the companies are re-evaluating certain claims; they have set aside $48 million in case the reviews show that they need to pay additional benefits. The companies have also set aside an additional $29 million for claims that are open now.

During an interview, Cioppa was unable to estimate how much of that money might be coming to Mainers. He said denied claims from all five states will be sampled for review, and Cioppa said Maine will be “actively reaching out” to other states to become parties to the agreement.

Another part of the agreement requires the companies to pay Maine $175,000 in fines. The state will get an additional $100,000 to cover costs associated with examining cases.

There will be a 24-month monitoring period, during which the insurance departments of the five states will conduct random sampling of claims. They’ll be checking to see that the companies have improved the claims handling process for current policyholders. There will also be a remediation program, with the improved procedures applied to “certain previously denied or adversely terminated claims” for residents in participating states.

Following the monitoring period, Maine and other monitoring states will conduct what’s called a re-examination. That process is designed to measure the effectiveness of the companies’ improved claims review process and could take up to six months.

Eric Cioppa says the Bureau of Insurance is willing and able to help people who feel they may have been wronged in the past. “If they know they have some rights they may not have been aware of, they can always call us,” he added.

You can reach the Bureau at 1-800-300-5000 or online at www.maine.gov/pfr/insurance.

Consumer Forum is a collaboration of the Bangor Daily News and Northeast CONTACT, Maine’s all-volunteer, nonprofit consumer organization. For assistance with consumer-related issues, including consumer fraud and identity theft, or for information, write Consumer Forum, P.O. Box 486, Brewer 04412, visit http://necontact.wordpress.com or email contacexdir@live.com.

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