CIGNA is Required to Give Significant Weight to Social Security Disability Insurance (SSDI) Awards as Part of Settlement

Settlement Also Requires CIGNA to Pay $1.6 in Fines/Fees and Up to $70 Million to Disabled Claimants Who Were Denied Benefits

On May 22, 2013, Connecticut Insurance Commissioner Thomas B. Leonardi announced that Connecticut, along with insurance regulators from Massachusetts, Maine, California and Pennsylvania, had reached a settlement with the CIGNA Companies over allegations that the Insurance giant had been improperly handling and unfairly denying Long Term Disability Claims.  This settlement is an important victory for thousands of disability claimants who, over the years, have seen their claims denied without sufficient basis.   

Pursuant to the settlement, any person from Connecticut, Massachusetts, Maine or Pennsylvania who had their LTD claim denied from January 1, 2009 to December 31, 2010 is entitled to have their claim reviewed pursuant to a "Remediation Program" set forth in the agreement.  (Remediation for California residents will cover claims from a longer time period: from January 1, 2008 to December 31, 2010.)  It is advised that persons who were denied during this time period seek the assitance of a Long Term Disability Lawyer. Connecticut LTD Lawyer

The agreement entered between CIGNA and these five states requires that the company change several of its practices with respect to the handling of claims.  Perhaps one of the most important changes that CIGNA must make is that, from now on, it must give "significant weight" to awards of Social Security Disability Insurance (SSDI) Benefits.  In the past, CIGNA gave very little weight to Social Security Disability Insurance awards.   In most denial letters CIGNA did not provide any specific reasons why it was disregarding Social Security's determination.  In many instances, the denial letters drafted by CIGNA Disability Claim Managers contained boilerplate language that merely stated in vague terms that CIGNA was not bound by SSDI awards becuase the standards used for determining eligibility under SSDI are different from the standards used to award benefits pursuant to the LTD policy.  This language used by CIGNA in its denial letters usually read as follows:

"We are aware that you were awarded Social Security Security Disability Benefits; however, the standard for determining disability under this policy may be different from standards used by the Social Security Administration (SSA)."

Other denials by CIGNA were even more shocking.  These denials simply stated that the award for disability benefits by the SSA was "considered" in making the determination for LTD benefits without specifically saying what weight if any was given to the award.  These denial letters usually stated:

"We are aware that you have been awarded Social Security Disability Insurance (SSDI) benefits by the Social Security Administration, and have considered that fact in our claim review."

If you have received such a denial letter, it is important that you contact a long term disability attorney.  Long Term Disability Appeals are quite complicated and it is probably not a good idea to try to go at it alone.  (See articles from my web page where I explain some the complexities that are involved in a long term disability appeal.)  Keep in mind that many long term disability lawyers, like myself, are willing to take these difficult cases on a contingency basis.  

I have noticed that in many instances, long term disability claimants become frustrated with the unfairness of the LTD claim process and give up too soon. Unfortunately, not all Social Security Disability Lawyers are willing to take on LTD appeals.  In the last NOSSCR* conference there was a great session about ERISA LTD appeals.  I know that NOSSCR members can do a great job at educating their clients and empowering them to obtain the disability benefits that they have earned.  I urge Social Security Disability Lawyers to learn more about this area of disability law and encourage their clients to take aggressive steps to protect their rights under the Long Term Disability policies issued by CIGNA. 

*NOSSCR is one of the largest organizations of Social Security Disability Lawyers and Representatives (SSDI and SSI).  

Our Office: Activism at the Local and National Level

In order to properly represent Social Security Disability Claimants, a competent Social Security Disability Lawyer must stay connected to the community that it serves. 

Those who know me personally probably have noticed how much I enjoy getting involved in social and political issues --particularly issues affecting those who suffer from disabling conditions and/or chronic illnesses.  Its a great way to give back to the people that I serve and... take a break from the work at the office. 

 This what I have been up to:

 

I just got back from Washington D.C., where I participated in the Spring Conference of the National Organization of Social Security Claimant's Representatives ("NOSSCR").  NOSSCR is the largest Social Security Disability Lawyer organization in the country.  The conference was a great opportunity to sharpen my skills as a Social Security Lawyer and lobby Congress in support of our our Social Security Disability programs.  Several distinguished Congressional leaders spoke before our organization including Sen. Tom Harkin (D- Iowa) and Rep. Xavier Becerra (D -California).  Becerra is the Ranking Member of the Ways and Means Sub-Committee on Social Security.  He gave a passionate speech in support of Social Security Disability Insurance and SSI.

May is Lupus Awareness month.  On May 5th, our office participated in the annual Lupus walk in West Hartford, Connecticut.  During the event we set up a table with educational materials regarding the Social Security Disability process. 

In addition, on May 20, 2013 I went to the Connecticut State Capitol to talk to our State leaders as part of our Lupus Advocacy Day.  Governor Malloy signed a proclamation officially declaring the month of May as Lupus Awareness Month.

Finally, I would like to add that this summer my office will sponsor a little league team in the Minnie Gonzalez Little League in Hartford, Connecticut. 



I can't wait for opening day!  The name of the team that I will be sponsoring will be: "Los Indios de Mayaguez".  I'm a big fan of my hometown's winter league baseball team and I'm really happy that I was able to name the team that I sponsor after them. 

Quick Roadmap of the Social Security Disability Claim Process

In my practice as a Social Security Disability Lawyer clients often request that I provide them with a quick overview of the process and a rough estimate of how long each step will take.  This roadmap shows the steps that an applicant must follow in order to win Social Security Disability.   Please be aware that the time that each step takes is merely an estimate.

Step	Timing(from beginning of each stage)
1. Initial Application for SSDI All correct application forms and supporting medical evidence is filed with Social Security.	An initial decision granting or denying benefits takes approximately six months.
2. Reconsideration If denied, a Request for Reconsideration must be made within 60 days. Usually, additional medical is presented at this step.	A Reconsideration decision takes from 45 days to six months from the time that a Social Security Disability Lawyer or the Claimant makes the request.
3. Hearing If a claim is denied after Reconsideration, a Request for a Hearing before an Administrative Law Judge must be made within 60 days.	It takes 24 months or more for an individual case to reach a Hearing in a Social Security Disability case.
4. Hearing Decision	You will receive a Hearing decision between two and eight months after the date of your Hearing.
5. Appeals Council If a claim is denied after a Hearing, an appeal can be filed with the SSA’s Appeals Council.	An appeal will take from six to 16 months following filing for a decision.
6. Federal Court Appeal If an appeal is denied, a request for review by the Federal Court must be made within 60 days.	A Federal Court case takes from 18 to 30 months after filing.

Law Office of                                                     

Iván A. Ramos, LLC                              

Connecticut and Massachusetts Social Security Lawyers

SSI & SSDI      

Exempt Disabled Combat Veterans from the 5-Month Waiting Period! Pass H.R. 1488

Pursuant to Social Security Rules, claimants who are awarded Social Security Disability Insurance Benefits (SSDI) cannot receive benefits during the first 5 months of their disability.  Social Security Disability Lawyers commonly refer to this rule as the “5-month waiting period”.  Recently, two members of Congress introduced legislation seeking to waive this 5-month waiting period for disabled veterans who are granted Social Security Disability Benefits.  This bill is known as the “Recovering Service Members Disability Benefits Act” (H.R. 1488) and was introduced by U.S. Representatives Glenn ‘GT’ Thompson (R-PA) and Dave Loebsack (D-IA).

The passage of this legislation will be extremely beneficial to Veterans who are recovering from injuries and are trying to transition to their life back home.   Last week I met with a Social Security Disability client who is recovering from physical injuries, as well as PTSD, after serving in Afghanistan.  I was shocked when I found out that he attempted to go back to work almost immediately after returning from the war.  He said that he went back to work right away because he needed to take care of the immediate financial needs of his wife and children.  I believe that his disabling condition was exacerbated by the stress of having to return back to work so quickly.

Rep. Thompson introduced the bill on the floor of the House of Representatives.  For a video of his remarks click on the link:

http://www.youtube.com/watch?v=vvcG2IPlRg0&list=UUNWX7lbWWvnNdzVMFI9DRiQ&index=7

In addition, Rep. Loebsack, the co-sponsor of the bill, stated: “It is unacceptable for our service members who have been wounded defending our country to have to wait for benefits or face financial hardship.  Instead of worrying about if they will be getting their benefits, they should be focusing on getting better,”  He also pointed out that: "Our veterans are already waiting far too long to receive VA benefits. They should not also be subjected to delays in their Social Security benefits.  This bill honors the sacrifices our wounded service members and their families have made for our country.  We owe it to those who have put their lives on the line protecting our freedoms to ensure that they are able to quickly access the benefits they need.”

H.R. 1488 amends title II of the Social Security Act to provide that the waiting period for disability insurance benefits shall not be applicable in the case of a disabled service member recovering from an injury or illness incurred in a combat zone.

The Recovering Service Members Disability Benefits Act does not expand eligibility for SSDI benefits or automatically approve individual requests, and all of the same protections used to prevent fraud and abuse of the program remain as defined under current law.  

New Online Services for SSDI and SSI Claimants

The Social Security Administration is expanding the services available with a my Social Security account, a personalized online account that people can use beginning in their working years and continuing throughout the time they receive Social Security benefits. More than 60 million Social Security beneficiaries, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients can now access their benefit verification letter, payment history, and earnings record instantly using their online account. Social Security beneficiaries also can change their address and start or change direct deposit information online.

“We are making it even easier for people to do their business with us from the comfort of their home, office, or library,” Commissioner Astrue said. “I encourage people of all ages to take advantage of our award-winning online services and check out the new features available through an online my Social Security account.”

Social Security beneficiaries, Social Security Disability Insurance (SSDI)  and SSI recipients with a my Social Security account can go online and get an official benefit verification letter instantly. The benefit verification letter serves as proof of income to secure loans, mortgages and other housing, and state or local benefits. Additionally, people use the letter to prove current Medicare health insurance coverage, retirement or disability status, and age. People can print or save a customized letter.

Social Security processed nearly nine million requests for benefit verification letters in the past year. This new online service allows people to conduct business with Social Security without having to visit an office or make a phone call, and very often wait for a letter to arrive in the mail. It also will reduce the time spent by employees completing these requests and free them to focus on other workloads.

People age 18 and older can sign up for an account at www.socialsecurity.gov/myaccount.

The Importance of the Work History Report in a Social Security Disability Case

In my experience as Connecticut and Massachusetts Social Security Lawyer, I have noticed that one of the most common mistakes made by SSI or SSDI claimants is that they fail to recognize the importance that their "work history" plays in the disability determination process. It is fair to say that many Claimants focus mostly on their medical conditions and neglect to provide the Social Security Administration with a precise description of the work that they performed prior to becoming disabled.

Any competent Social Security Disability Lawyer knows how important it is to take some time in completing the SSA's Work History Report. This report can be made using Social Security Form 3369 or by completing the electronic "Adult Disability and Work History Report" provided in SSA.gov. If you need help with this form, you should contact a Social Security Lawyer who handles these types of cases on a regular basis. Every week, my Connecticut and Massachusetts office helps 3 to 4 claimants complete these forms.

A well done Work History Report is important for three main reasons:

 

1.    This work history report will assist the Social Security Administration understand how your injury or illness affects your ability to do the work that you performed in the past. Social Security focuses on the work that you performed on the 15 years prior to the date when you became disabled. In the report, it is important to describe the specific physical requirements of the jobs that you held during these 15 years.

2.    This report also helps Social Security determine whether you will be able to transfer your skills to any new type of work that you have not performed in the past 15 years. For this reason, you must also explain the level of skills that were required at your past jobs.

3.    A good work record enhances your credibility as a Claimant! Pursuant to Social Security Disability Rules, a Claimant who worked consistently before becoming disabled must be given more credibility than a claimant who was never able to stay employed for a considerable period of time. When assessing a claimant’s pain and subjective symptoms, it is entirely appropriate to consider his or her prior work record. See 20 C.F.R. 404.1529(c)(3) and Social Security Ruling 96-7. The Claimant with an excellent work history are entitled to a favorable credibility inference.

Our Office will be at the May 5th Walk to End Lupus

MAY 5, 2013 Blue Back Square 50 South Main Street West Hartford, CT 06107

As a Social Security Disability Attorney I believe that it is essential that I stay connected with those who advocate for persons with chronic conditions.  For this reason, our office will be at the May 5, 2013 Lupus Walk in West Hartford Center.  Please join us, raise some money and awareness, and... stop by the table with our office display to say hello.  Join the Lupus Foundation of America, CT Chapter in celebrating their 40th Anniversary of raising awareness and educating the public about lupus as well as providing educational programs and services to all people with lupus and their families. WALK TO END LU?US NOW™ is the signature event of the Lupus Foundation of America, Inc. In more than 50 cities across America, thousands of people walk to make a difference in the lives of those affected by lupus and to raise essential funds for research, education, and support services. Join us for a half-day day of fun, food, and friendship with activities for the whole family! Walkers can stroll the 1/4 - 3 mile long walk to show thier support in raising the awareness of lupus.