LONG-TERM DISABILITY CLAIMS
Filing a long-term disability claim can be a tedious process. If you miss one deadline or complete a form incorrectly, your entire claim might be in jeopardy. If you have long-term disability insurance and become unable to work, call The Buckley Law Group today.
Long-term disability insurance is governed by the Employee Retirement Income Security Act which provides very specific procedures that make it crucial to hire an attorney with long-term disability experience. When you hire The Buckley Law Group, we will file your application and work with you and your physicians to ensure that the right questions are asked and your file contains the necessary medical evidence. The earlier you hire a long-term disability attorney, the easier the process will be for you. Call our office today for a free consultation on your legal options.
CIGNA FAILURE TO PAY CLAIMS
As lawsuits involving billing disputes and out-of-network healthcare providers increase, the Buckley Law Group continues to investigate the potential claims against Cigna for its failure to pay legitimate claims and breaching the terms of benefit plans.
In Connecticut General Life Insurance Company v. Humble Surgical Hospital, LLC, CA No. 4:13-cv-03291 (S.D. Tex. June 1, 2016), Cigna sued Humble Surgical Hospital, LLC, a physician-owned hospital (“Humble”), under ERISA and state common law for overpayments made to Humble for out-of-network services provided to members of health care benefit plans. Cigna alleged Humble used fraudulent billing practices consisting of waiving plan members’ financial responsibilities, and argued that as a result, pursuant to the policy’s language, Cigna was only required to pay the same proportional amount as paid by the plan member.
The court rejected Cigna’s argument under ERISA’s standard that the summary plan must be written as an ordinary person would understand it. The court determined that the ordinary person would expect Cigna to pay its full share, regardless of what the patient paid. The court found that Cigna abused its discretion, and as a result, Cigna was ordered to pay $13 million to cover underpaid claims and ERISA penalties.
This case shows that not only will Texas courts enforce that Cigna act in good faith, but will also hold Cigna responsible for payment of services rendered to Cigna insureds.