Disability MO

[prideluv]

Missouri

I have an appeal pending with Cigna for Long Term Disability. I requested a copy of all the records they were using in considering my appeal. When I recieved them, I found a post that I had made on a support group message board for Cigna customers. I was telling them my story of dealing with Cigna and how horrible I was feeling.

This means that Cigna has someone scouring the internet looking for this stuff to use against us. My name was not on the post, so they had to do a search with my email address to find out who I was.

My question is, can they use this information against claimants in considering their claiims?
I feel so violated.

 

[Beth3]

"My question is, can they use this information against claimants in considering their claims?" Sure. It depends on what is said and how identifiable it is. If I write on a message board how I'm planning on defrauding an insurer and they can positively identify that as me due to the circustances of my claim or investigation via my ISP, why wouldn't they use that? They'd be crazy not to. (I'm not suggesting you're defauding anyone - just giving an example.)

"This means that Cigna has someone scouring the internet looking for this stuff to use against us." You said this was a group message board for CIGNA customers. It doesn't take a lot of scouring of the internet for a company to become aware of and keep an eye on Boards that reflect public opinion about their company or alert them to issues that may be of importance. All one would have to do is type in "CIGNA" in any search engine and wade through the hits.

"I feel so violated." If you post private information on a public web site, ANYONE can access it. And if you posted your e-mail address, any fifth grader could have found and identified you.

 

[prideluv]

Since it is public knowledge anyway, here is the post they copied.
They also copied the reply of another member that offered to talk with me. She had included her phone number on it.

Hi all

I wanted to share my experiences with Cigna HMO. I had no trouble
with them until I need surgery. My doctors said I needed a
pannuectomy ( basically a Tummy Tuck) to ease the pain in my lower
back. With multiple doctors letters and documentation stating it was
restorative and not cosmetic, they still denied me. Well, I
eventually became unable to perform daily activities and began to put
on weight. I am now morbidly obese and have been on disability since
5/03. They dragged the approval for WLS out by demanding 2 26 week
medically supervised diets first which is now a mute point because my
FMLA leave is maxed out and my work now cancelled my insurance with
them.

Now, to top things off, they have denied me my long term disability
saying my doctor did not provide enough subjective documentation to
show my limitations. They want proof that my pain is bad enough.
Now how does one prove pain? I asked them and they cant answer it.
Mind u, I have been receiving Short term disability for the past 6
months. They claim the criteria is different when u go into long
term. Cigna HMO even had me evaluated by a physical therapist before
approving a motorized scooter.

So, as of Dec 1, I will have 0 income. I am alone and have a house.
I am going to lose my home and end up in a shelter and am actually
considering ending my life. Because of this, I am making myself very
sick. If I get a lawyer, which I dont have any money for, it will
just get dragged out for years.

Well, that is my story as it is at this moment.

Donna

 

[Beth3]

The criteria to qualify for short term disability benefits vs. long term disability benefits are often quite different, with the requirements to meet the definition of disability in the LTD plan quite a bit more onerous.

 

[ALawyer]

Short term disablity is a relatively limited exposure for an insurer -often only 2-6 months of benefits. That's quantifiable and not worth fighting in most instances.

For STD the definition of disability is typically inability to do functions of the job you were holding due to illness or injury.

Long term means just that, LONG TERM benefits, perhaps for 10, 20 or more years.

Often there are different carriers involved. And sometimes there are significantly different definitions. But typically for the first 2 years the definitions of disability in LTD policies are rather similar to those for STD and then it changes to a far broader term, such as an inability to do any gainful employment for which you are or could qualify.

But insurance companies -- facing long term payments -- are tougher on LTD. And some of them have been guilty of egregious bad faith in denying benefits and forcing the employee to sue as a matter of practice, except in the most clear cut cases. As punitive damages are not available under employer plans (ERISA bars punitives) too many of them deny and wait for you to sue.

What are you waiting for?