After Good Morning America aired a story about Susan Kristoff, a Florida woman disabled by Stage IV breast cancer, and her Attorney Alicia Paulino-Grisham’s successful two-year battle for Susan’s disability insurance benefits with Cigna Insurance Company, the national news show was bombarded with similar stories of unreasonable denials and delay tactics by the insurance carrier.  As Attorney Paulino-Grisham explained in the segment that ran on April 25, 2008, Susan’s case was certainly not isolated, but an industry wide problem effecting thousands of claims.  

Because of the multitude of similar compelling stories pouring in following the April 2008 segment, Good Morning America aired a follow up story on June 27, 2008.  Good Morning America featured several individuals who were denied disability benefits by Cigna, despite ample medical evidence of disability provided by their treating physicians, and for several, despite payment of disability benefits by the Social Security Administration that declared them unable to maintain any gainful employment.  Two of the claimant’s highlighted in the follow up segment are Florida residents that hired Attorney Paulino-Grisham’s firm, Disability Insurance Law Group, after they were unsuccessful in obtaining benefits from Cigna.  Elizabeth Bara-Skowronek of Boca Raton, Florida was initially approved by Cigna for disability insurance benefits based on her severe degenerative disc disease and cardiac condition.  After being declared by the Social Security Administration to be unable to maintain gainful employment, Cigna denied the grandmother of two further benefits, despite significant evidence of her inability to work, and against her physicians’ advisements that she should not return to work.  Bara-Skowronek told Good Morning America that Cigna’s denial has financially devastated her to the point where her son had to purchase her medications as her Mother’s Day gift.  She hired Disability Insurance Law Group after her fight with Cigna proved futile.  The second client interviewed was Vickie Burr of Fort Pierce, Florida who built her career as a phlebotomist and patient service representative at a local hospital.  After undergoing significant back surgery, Burr was diagnosed with failed back syndrome due to permanent nerve damage in her back that cannot be corrected by surgery. Following surgery, Burr has been left bedridden much of the time due to her severe low back and neuropathic pain.  Her pain and limitations are so severe that significant oral narcotic medications did not provide relief, and her doctors had to surgically insert a morphine pump into her back.  Despite this, Cigna denied her claim for disability insurance benefits.  Unable to get out of bed for her interview, she had to be filmed for the Good Morning America segment lying down.  She explained that following Cigna’s denial of benefits, there have been weeks that she could barely afford groceries.  She hired Disability Insurance Law Group after Cigna refused to pay her claim.  

The problem appears to be that the vast majority of disability insurance claims that are filed fall under the Employee Retirement Income Security Act of 1974 (“ERISA”).  ERISA covers most group health and disability insurance plans provided by employers as an employee benefit.  Under the current ERISA law, insurance companies such as Cigna have full discretion to decide whether an individual is eligible for benefits under the insurance plan and are also responsible for the payment of benefits (and, hence, profit financially from claim denials).  Obviously this is an inherent conflict of interest, made worse by the fact that the courts have determined that even if a court finds that an insurance company’s denial of benefits was wrong and should be overturned, insurance companies are only required to pay a claimant the benefits owed under the insurance policy.  According to Attorney Paulino-Grisham, because there are no penalties for unreasonably delaying and denying claims under ERISA, this has the effect of encouraging insurance companies to act in bad faith in order to profit financially from claim denials.  As the Cigna claimants each explained in the story that aired on June 27, 2008, a delay or denial of benefits when you are unable to work can be financially and emotionally devastating.  Many people lose their homes, cannot pay for treatment, or fall deeper and deeper in debt.  However, under ERISA, insurance companies are never required to reimburse claimants for the effects of their actions. Attorney Paulino-Grisham told Good Morning America that insurance companies engage in “slow walking,” the practice of purposefully delaying a decision on a claim, because they know that many disabled claimants will eventually give up their pursuit of benefits.  Moreover, if a claimant is successful in court, there is no penalty for an unreasonable denial of benefits, and insurance companies know that even if they lose in court, they will only have to pay back the benefits that were owed under the insurance policy anyway.

Determined to change the law in order to provide more accountability for insurance companies that issue ERISA covered disability and healthcare policies, the partners of Disability Insurance Law Group, Alicia Paulino-Grisham, Cheryl Flowers, Maggie Smith, and Mindy Chmielarz, took Susan’s story to Congresswoman Debbie Wasserman Schultz, of Broward County, Florida.  Good Morning America followed Disability Insurance Law Group to Washington D.C. for their meeting to discuss the needed changes in the law.  Appalled by Susan’s story and the lack of accountability for insurance companies, Congresswoman Wasserman Schultz pledged to draft a bill that will allow for penalties against insurance companies that engage in unreasonable delay and denial tactics.  The Congresswoman explained to Good Morning America "Right now there is no punishment . . . . 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."  Disability Insurance Law Group is working with the Congresswoman in drafting the bill.
 
Attorney Alicia Paulino-Grisham is a partner with Disability Insurance Law Group which focuses on individual and group disability insurance claims at all stages of the claims process.  For more information please visit: www.dilawgroup.com.

Contact:
Toni Rewerts
Disability Insurance Law Group
1111 Hypoluxo Rd., Suite #110
Lantana, Florida 33462
Toll Free: (888) 644-2644
Tel: (561) 202-9170
Fax:(561) 202-9194
E-Mail: This email address is being protected from spam bots, you need Javascript enabled to view it
Website: www.dilawgroup.com

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