Denied: Fighting For Insurance Coverage

June 27, 2008 — -- After a "Good Morning America" Gets Answers story in April about a breast cancer survivor's battle to get disability insurance benefits from Cigna Group Insurance, we received a flood of e-mails from viewers who were struggling with similar problems.

Our first story featured Susan Kristoff, from West Palm Beach, Fla., who spent two years trying to get those benefits.

"It was a daily eight hour job just trying to fulfill the informationthat Cigna was requesting," Kristoff said.

During our investigation into Susan's case, Cigna reversed course and paid her claim.

After Kristoff's story aired, "GMA" received a flood of e-mails from people across the country who said they too had been unfairly denied disability benefits from Cigna, despite submitting extensive medical evidence that they were too sick to work.

Kristoff and her lawyer, Alicia Paulino Grisham, blamed her troubles with Cigna on an industry-wide practice of deliberately delaying benefits, which Grisham and other critics call "slow walking."

"The insurance companies know if they deny and deny claims that many ofthe claimants will never pursue their claims," Grisham said.

Cigna wouldn't talk to us about Kristoff's case, but the insurance trade group, America's Health Insurance Plans, said cases like hers were the exception, not the rule.

"What I do know is there is a process, it's designed to be fair," Susan Pisano, a representative for the trade group, told us then.

More Stories of Claims Denied

But dozens of people wrote in to share stories similar to Kristoff's.

Lorie Bailey, a former police fingerprint analyst, has been fighting Cigna for nearly three years.

"This fight has caused me to go deeply into debt and I have losteverything I worked hard for my whole life," Bailey said.

Others like Bob Eklund, complained Cigna denied he was disabled, despite mountains of medical evidence the former engineer submitted.

"I can't explain it," Eklund said. "You know, what do you do then when your company says, 'You can't come back to work.' ...What can you say?"

After several years, Cigna also cut off car wreck victim Eugene Czachor from his disability benefits, saying he should be able to return to work.

"I have to struggle from day to day, as to which I can afford - my utilities, my food, mortgage or medication."

Janine Pendley suffers from a debilitating lung disease.

"I purchased insurance to protect myself and my family. I see mybusiness destroyed, my savings depleted and my family battling to keepour home," she said.

In Ursala Guidry's case, Cigna paid benefits for a while, then stopped.Cigna told Guidry she should be able to work full time, though she wassuffering from advanced breast cancer.

Her husband, Michael Crommie, said, "We thought it was crazy because my wife was so incredibly disabled. It threw us into a panic because we didn't know how we would pay for our mortgage and support our children."

Cigna told grandmother Elizabeth Bara Skowronek she should be able towork, despite her heart disease.

"I can't afford to visit my grandchildren," Skowronek said. "This year for mother's day my son bought me medications. I never believed this could happen."

After several years, Cigna also cut off car wreck victim Eugene Czachor from his disability benefits, sayinghe should be able to return to work.

"I have to struggle from day to day as to which I can afford," he said, "my utilities, my food, mortgage or medication."

Too Little, Too Late

"GMA" went back to Cigna, who said they wouldn't discuss specific cases,even though everyone who wrote in gave them permission to talkto us.

They did agree to a non-recorded phone call with their chiefmedical officer and gave us a written statement which said Cigna pays 90 percent of their claims and that a majority of their clients are satisfied.

U.S. House Rep. Debbie Wasserman Schultz, D-Fla., heard our report about Kristoff and says she wants to pursue legislation that would penalize insurance companies if they wrongly deny claims.

"Right now there is no punishment," Wasserman Schultz said. "I'm going to make sure that we pursue these insurance companies and make sure that they are covering the claims that they are supposed to until we can get this law passed."

Going after insurance companies' that may have unfairly denied claims won't come soon enough for Ursala Guidry.

"Three months after we got the money from Cigna my wife died from breast cancer," her husband Michael Crommie said. "I can't help thinking about the time my wife wasted during her last year on Earth fighting an unethical insurance company."

Hope for Claimants?

There is hope for some of the people mentioned here.

After three years of fighting with Cigna and four appeals, Lorie Bailey's lawyer recently received a call from the insurance company. After "GMA" Gets Answers began looking into her case, Cigna has now reversed course and is paying Bailey's claim.

She will be getting back benefits that she estimates will equal about $80,000. Bailey says it will help piece her broken life back together.