Unbelievable. It is 2013. Mother was obviously in an altered state in her favorite rocking chair for the past few years…. Mother had thought by now that perhaps she would be able to give this post a more upbeat title than before (see here). Not so lucky, or in reality it’s not about luck. Things just suck. Still?
Mother never in her life thought of herself as a “victim;” instead, Mother showed disdain for such types. Even now, as the toilet continues to flush on Mother’s life, she considers herself less of a victim and more of being intertwined in a lot of bad shit. The more complex things in life are, the more time it takes to get things worked out. Such is the case with Mother’s ongoing battle with Cigna (or as one of Mother’s friends calls them “Shit-on-ya”). Ruthless, malicious, unprofessional, lying, despicable are all kind ways to describe this so-called disability insurance company. You know the old phrase, “the check is in the mail?” Cigna used this one on Mother. Of course she had her doubts, but after sufficient assurances, she actually thought Cigna was going to life up to their side of the agreement. Wrong.
A few bits of information about Cigna, and disability insurance that are employer-sponsored. First off, this is NOT medical insurance, so there will be no useless political rants about Health Care Reform (Mother does not support the bill that was passed), although some of the disability insurance companies like Cigna also have health insurance plans. Second, and probably most important, Employer-sponsored disability insurance plans are protected under Federal laws, namely ERISA, the Employee Retirement Income Security Act, passed in 1974, and one of the most complex and convoluted bills still in existence. Mother asks right away, “do you see anything about ‘insurance’ or ‘disability’ in the title of this bill?” NO! This bill was created to protect employee pensions at a time when there was legitimate concern that companies would not be able to pay out when people retired. Right before the bill was sent to the president for signature an amendment, never argued or discussed in Congress, was inserted, adding ambiguous language that has since been the cornerstone of ERISA. Mother is not a lawyer so she will not provide any further detail; it is up to you the reader to do a little homework and research. There is a mountain of information on ERISA, disability and how these insurance companies are protected by the law and as a result, abuse the shit out of people. The gist of it all goes something like this:
You work for a company with an ERISA Disability Plan, usually provided free of charge. In the event you find yourself unable to work due to medical reasons, you can apply for short term disability benefits (usually up to six months) and if you are disabled for beyond this time period, you apply for long term disability benefits. The plans usually pay a percentage of your salary; as time goes on, the percentage goes down.
As part of the process, you have to release your medical records to the insurance company; they contact your doctors for information, test results, etc. After all of this information is received, the insurance company “reviews” it – usually a claims manager, a nurse and the so-called doctor at the company – and they give you an approval or denial. If approved, they almost never give you the amount of time your doctor recommends. If denied, you must go through an appeals process, directed by ERISA rules. This can takes months to years, especially if you are denied more than once.
If you chose, you can sue the insurance company for the benefits you are due. This is where things really start to suck. In adherence of ERISA law, the suit can only be filed in a Federal Circuit Court; no suit on the State level is permitted. You cannot sue for anything other than the benefits you are due. You cannot sue for interest, punitive damages, hardship, etc. In most cases, you cannot sue for legal fees, either. Do you see what’s going on here? Do you see why the disability companies have next to nothing to lose if they deny your claims? They count on the one who is suffering to bail out, due to lack of funds, which is the case more often than not. And even if the Court rules in your behalf, the amount your are given is usually a pittance and goes straight to legal fees. In some cases, the Court will send the claim back to the insurance company to do another review of your file, possibly leading to another denial and dragging things on even more.
How ERISA as it stands can go unchallenged for all of these years is beyond belief. Mother’s saving grace is that she found lawyers who are willing to follow through with everything despite Mother not being able to pay them yet. Aside from this, Mother has used all of her assets, is losing her house, cannot pay her utilities and owes money to so many people she has to keep a list. Most claimants are in the same boat and end up filing for bankruptcy and dropping legal proceedings.
Which leads Mother back to her opening thoughts. It is hard for Mother not to feel victimized; if anything she feels that she is a victim of a very bad law initially created to protect people in their retirement years. So much for that. Other than this, everything is GREAT!
I’m sure many of you are familiar with The Onion. Sometimes they hit the mark, sometimes not. That is often the case with satire. However, not only does this satirical article hit the mark, it hits the bullseye. This article may be fictitious, but it names real names of CIGNA execs who deserve the ball-busting they are given in this article, so please check out “Insurance Company Celebrates 50 Billionth Fucking Over of Customer.”