CIGNA Group Insurance sent two statements to "Good Morning America" regarding today's segment about Susan Kristoff's attempts to get longterm disability benefits from the company, which insured her through her workplace.
Statement regarding Susan Kristoff's Long-Term Disability Insurance Claim From CIGNA Group Insurance on March 20, 2008:
We understand and respect that this is a very difficult issue. The plan under which Ms. Kristoff is insured does not provide coverage for a disability arising from a condition for which she was treated before obtaining the insurance, which is a common provision in most longterm disability benefit plans. Therefore, our benefits decision has not been based on whether Ms. Kristoff has a disabling condition. Instead, it is based on whether her disability was the result of a condition she had before she joined the plan.
We have a thorough and fair process through which we make claim decisions. Accordingly, Ms. Kristoff's case, including medical records from her treating doctors, was originally reviewed by a CIGNA physician and also by an independent, board-certified oncologist in August 2007. At that time, we provided her with information about how to obtain an additional review, or appeal, in her case. The appeal process is an important consumer protection, and we encourage individuals to participate in this process if they would like an additional review of their claim.
In February 2008, an appeal was requested and we received the information to be reviewed under the appeal from Ms. Kristoff's attorney about a week ago. That information is now being reviewed by an independent board-certified oncologist who was not involved in the original decision. We expect that review will be completed by the end of March, and we will make a decision about the appeal once that independent review is complete.
We believe it is important for your viewers to know that having disability insurance is good protection against the unforeseen and should be part of an individual's broader financial security plan, which might include a combination of insurance policies, savings accounts and other financial security investments.
As with any type of insurance, it's important for consumers to understand what their policy does or does not cover, to ensure they are adequately protected through a variety of means to help them through an unforeseen event. We also encourage consumers to understand how their plan works -- such as how to file a claim or participate in the appeal process. If consumers have questions about their specific policies with us, we encourage them to call our customer service line or talk with their employer. We also make benefit and claims information available online.
Statement Regarding Susan Kristoff's Long-Term Disability Claim From CIGNA Group Insurance on April 2, 2008:
Statement from Allen Woolf, M.D., Chief Medical Officer, CIGNA Group Insurance
CIGNA's goal is to ensure that our customers receive all of the benefits to which they are entitled, and to help individuals return to work from a disability as quickly and safely as possible. Employers who provide these benefits expect that we will fairly administer each claim in accordance with their purchased policy.
Most claims for disability are approved after the initial review process. Whenever a claim is not approved, the consumer is advised of his or her right to appeal the decision and given clear instructions on how to obtain a second review. When a consumer asks for a review, CIGNA ensures that a comprehensive review is conducted as quickly as possible.
CIGNA's appeal process is designed to provide consumers with a fair review of coverage decisions. Appeals are reviewed without regard to the initial decision and are conducted by a team not involved in the first decision. If the decision was based in whole or in part on medical information then the review would include an independent physician.
In this instance, a review of Ms. Kristoff's case on appeal found, based on the additional information collected during the process and reviewed by our internal team and by an external physician, that her disability benefits should be covered.