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Phillip A. Tatlow recently filed two new Federal Lawsuits in the U.S. District Court for the Eastern Division of Missouri against Cigna Insurance Company & Life Insurance Company of North America. He named the employers and plan sponsors in both suits as well. In one case the employer was Cloud Stream, a mining company out of Wyoming, who employed a Missouri resident. In the second case the employer was Southeast Missouri Hospital, who also hired a Missouri resident. Both Plaintiffs were insured under policies sponsored by their employers but administered and funded by Life Insurance Company of North America, doing business as Cigna Insurance Company.

The disability policies were to provide benefits to the Plaintiffs for monthly benefits if the insureds became unable to perform their own jobs/work and after two years, they could not perform any employment in the labor market, based upon their age, experience and occupations. Both clients were given the run around by Cigna for many, many months and well over a year before receiving a final denial. It is important to understand that if the plan is controlled by a valid ERISA plan, the insured must follow the plan appeals process, or his or her rights could be waived.

Both Plaintiffs had the right to two separate administrative appeals of the denial of their claims. After the first denial they hired Mr. Tatlow to handle the cases. Mr. Tatlow submitted vocational evidence and new medical evidence that showed they were unemployable in the open labor market. They both received Social Security disability benefits, but Cigna ignored the Social Security awards and the new evidence, hired consultants that were paid for by Cigna. The Cigna consultants, even though they did not treat the persons, wrote letters saying that the two different Plaintiffs were not disabled and there was no objective evidence to support the denials.

In both cases the Plaintiffs claim that Cigna used false and fraudulent evidence from their consultants or claim’s persons to deny their claims. In one of the cases Plaintiff claims that Cigna’s Physical Therapist that tested him, cut the test short by half an hour because the therapist was worried about the Plaintiff having a heart attack (Which is what caused him to have to stop work at the hospital and put him on Social Security in the first place). He claims that the therapist told his intern that he was going to inflate the test results and make it look like the Plaintiff could do a whole hour of testing, when in reality he had to stop due to increased blood pressure, poor breathing and physical concerns. The therapist hired by Cigna wrote a false report on his findings and Cigna, despite Plaintiff telling them that the results were fraudulent, relied on the false report by the therapist and denied the claim. In the second case, Cigna, in the denial letter, claimed the treating nurse practitioner told them that the Plaintiff could work. The Nurse Practitioner claims this is a misrepresentation and that she told Cigna that the Plaintiff was actually worse off medically than when the claim had started and that she could not work.

Despite this evidence, Cigna denied the claim relying on false information in the claim’s file and despite being confronted with it. In the denials of both claims, Cigna did not even attempt to justify using false information, they just denied the claims and ignored the arguments that the consultants they hired were fraudulent. Mr. Tatlow claims in the two lawsuits that Cigna is engaging in a pattern and practice of bad faith and improperly denying ERISA long term disability claims by relying on false and fraudulent information, by hiring consultants or experts that present false evidence, or who do not examine or test the patients and that this constitutes a breach of fiduciary duty owed to the insured Plaintiffs. He alleges in the lawsuits that there are several other people that he is representing that have also been treated in the same manner by Cigna.

If you or your loved one has been denied by Cigna Insurance Company or Life Insurance Company of North America for ERISA long term disability benefits based upon similar tactics, it is important to hire an attorney that is knowledgeable in ERISA law. This is a complex area that many general personal injury attorneys do not handle. Mr. Tatlow has handled over 125 ERISA disability cases and has litigated with some of the top firms in the country on such cases. He has had success in both medication and litigation of the ERISA cases. See our other articles and blogs on your rights under ERISA and case summaries for more details.

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