CNA ERISA Insurance

I have been disabled since 1997 following back surgery. I was covered thru work with CNA Insurance. They cut off my disability payments in March 1999 based upon a report by their hired gun (a physical therapist), even though I was certified as 100% diabled by an orthopedic surgeon and approved by Social Security Disability (which I have been told has a much higher threshhold than private insurance companies). I cannot find and attorney who will represent me. The reason? It is a very winnable case. However, I did not make enough money so that it would be profitable for an attorney to try the case. It has to be filed in federal court. Expert witnesses must be compensated. The ERISA law is written to benefit the insurance companies and throws the consumer to the lions. Even if the consumer wins the case, the insurance company does not necessarily have to pay attorney costs. All they have to do is say they had a good-faith basis for denying the claim (i.e. a report by their hired gun). The insurance companies have lawyers in their employ, so they do not care about going to court. Tehy are aware that the average person does not have the resources to fight them in court. I was told by an attorney that these cases are only attractive to them if a person had a yearly salary of over $100,000. Once again, it isn't the righteousness of your case that counts, it is the amount of money you have. Is this equal justice under the law or only equal justice for the rich? If you have a similar problem or know someone who does, I would love to hear from you. This is a warning to everyone out there. I never thought I would be disabled, I suppose nobody does. This could happen to you or someone you love. I am hoping I will hear from people with a similar problem in the hopes that a class-action suit can be filed against CNA in order for it to be profitable enough to an attorney to consider taking the case. I have written to my U.S. Senator. This law must be changed in order to protect the little guy. Thanks for your attention, hope to hear from you.

Thanks for the note and hopefully it will attract some attention here, perhaps from someone who knows a bit more than I do in this area regarding laws that might push towards a more satisfactory conclusion or who may be interested in the case. We plan on putting up a section for "laws you'd like to see" and we'll include this one in that area.

UNREAL!!!!!!!

hey nonnie,sorry to hear about your situation.back in novenmber 2002,i was mugged and robbed,and beaten till i blacked out.i suffered a fractured skull,brocken lower back,i have had 2 surgery's at c-5..c-6,and c-4...c-5.cna is my insurance company and they are absolutley horrible.i still have at least 2 more surgery's that must be done........l-5..s1,they took bone out of my right hip on both cervical surgeries,and had to replace some of the bone they took out with coral(yep! right from the ocean)anyways i live with severe pain every day of my life now,i can't stand or walk for any long periods of time because of my hip and the sciatic nerve in my right leg.i feel for you.i was just screwing around on the puter and somehow landed right on your page.cna paid me my short term dissability,but as soon as the short term ran out they denied me long term dissability......i couldn't believe it!!!!!i have one of the best nuerologists in south florida writing them reports as to my condition and they still denied me.it was my surgeon who suggested to me first to go after them and sue.easier said than done with this damn erisa laws.we should be able to go to a STATE COURT and tell a JURY whats going on and let them decide.i gotta run nonnie,but you hang in there,and lets hope everything turns out ok...
scott

Insurance companies are generally not your friend. Before I became a personal injury attorney, I always assumed that insurance companies are there for you on a rainy day. "Like a good neighbor?" Not like any good neighbors I have!

Bad faith legal action against insurance companies is becoming more common these days. In fact, one of the most egregious examples of bad faith denials involves the disability insurer UnumProvident. There is talk that bad faith claims and class action lawsuits against Unum will be the largest in history. We'll see.

Of course, the law should protect those who cannot afford protection. This is the point of the class action lawsuit system. Trying individual claims is quite expensive. That's why there have to be sufficient damages to make it worth an attorney's time. The class action was designed so those with small damages could be lumped together into one large case, making the damages in the aggregate substantial. If you can find others who experienced similar difficulty with CNA, a class action may be possible.

You might want to check out this firm, Turley, Redmond and Rosasco. I don't personally know anything about them, but from the looks of their web site, they might have some experience with litigating bad faith claims against CNA.

Insurance companies are generally not your friend. Before I became a personal injury attorney, I always assumed that insurance companies are there for you on a rainy day. "Like a good neighbor?" Not like any good neighbors I have!

Bad faith legal action against insurance companies is becoming more common these days. In fact, one of the most egregious examples of bad faith denials involves the disability insurer UnumProvident. There is talk that bad faith claims and class action lawsuits against Unum will be the largest in history. We'll see.

Of course, the law should protect those who cannot afford protection. This is the point of the class action lawsuit system. Trying individual claims is quite expensive. That's why there have to be sufficient damages to make it worth an attorney's time. The class action was designed so those with small damages could be lumped together into one large case, making the damages in the aggregate substantial. If you can find others who experienced similar difficulty with CNA, a class action may be possible.

You might want to check out this firm, Turley, Redmond and Rosasco. I don't personally know anything about them, but from the looks of their web site, they might have some experience with litigating bad faith claims against CNA.

CNA is among the worst in terms of denying and stonewalling anyone who isn't a quadriplegic.

I have MELAS, a genetic metabolic disorder that has caused me to have several strokes that have left me in continuous severe pain and with progressive memory difficulties.

Despite having top neurologists at three different hospitals certify me has 100% disabled, my attorney was unable to get them to even make an offer during our appeal.

Mind you, CNA totally ignored the 45/90 day time limit ERISA puts on appeals, etc. After over a year of correspondence they still haven't formally replied to our appeals.

I too am frustrated that they can't be taken to a jury trial, and that the worst that can happen to them is being forced to pay what they should have in any case. There are no penalties for denying obviously valid claims, and there is no assurance that I will be able to even win attorney fees on top of what they owe me.

The fact that the people whom they take advantage of are disabled makes it very difficult, if not impossible, for them to organize a class action suit, because the large majority of us are just too ill to put in the time and effort to follow through on such a thing.

My current attorney is shocked that they haven't even made an offer, and at this point is trying to back out of the case due to his own health problems. Does anyone know of a firm specializing in this type of litigation in the southeast Michigan area (Wayne/Oakland/Washtenaw Counties)?

I have just had a situation similar to this arise. I have been drawing longtern disability benefits thru Cigna Insurance, and Social Security disability benefits for 12 yrs. A previous functional capacity evaluation in 2001 indicated that I was incapable of working.( I have fibromyalgia, and (according to a couple of "hired gun" WC drs, bipolar disorder, possibly schizophrenia.I also have a history of bouts of major depression)Then this spring, Cigna sent me for another functional capacity evaluation at a place of THEIR choosing, and which they paid for it. Suprise surprise(not!), after spending 4 months shopping the test data around, they got somebody to day I'm capable of sedentary work.
Basically the same thing has happened EXCEPT that at this point they have not terminated my benefits, and are waiting for a response from my own dr, who I have only been with for about a year( I moved),she cannot possibly know all the issues I have because we can't seem to get my medical records from my previous Dr. I'm inclined to think that she will not concur with the hired guns findings, at least not without more information and possibly more tests.
My questions;
>Can I make a "presumptive strike" protest or appeal to prevent Cigna from cutting my benefits or harrassing my personal dr to concur with their "hired gun"? Please understand, this is a DISABILITY benefit , it is not in any way related to Workers Comp.I have been drawing these benefits for 12 yrs, and per a phone conversation with my "case manager", there is no question of my disability previous to this.I am unclear at this point whether any rehab or retraining will be made available,any kind of "safety net",whether I will be able to resume drawing benefits if returning to work causes my conditions to worsen. I would think after 12 yrs( and no I have not gotten better!)that they would be just about obligated to offer some kind of support, not just say that one or 2 persons( paid by them)said I was capable of limited work and cut me off. There is 12 freakin' years of precedence. They are not questioning that up until now I have been disabled and totally unable to work.
>Cigna Insurance was the one who requested and paid for this Functional capacity evaluation. They chose the place. I think this is inherently unfair.And I'm not sure just how much additional testing( like a psych eval) MY insurances( MediCare and a supplemental policy) will pay for. Since it is Cigna Insurance who is pushing this, shouldn't they have to foot the bill if my dr feels she needs other testing/more information before she can make a decision.
>If I notify my former dr's office that I am PERSONALLY coming to get my medical records, they have to give them to me, right?( yes I realize I'd have to give them SOME notice.) It's like 100 miles away but I think I can pay one of the few friends I have here to drive me,) if
>Might not people of low income be assisted by Legal Aid or other advocacy groups?

Let me note right here that this is a longterm disability policy that I PAID PREMIUMS ON FOR 10 YEARS.
I have been re evaluated twice by Social Security since I began drawing benefits, and both times it was determined that my disability continues.
So is there anything I can do to protect myself, other than relying on my personal dr? If it seems like a good move, I can certainly go down to my previous dr office and DEMAND my records,provided I have a legal right to do so.
Cindy O