Disability insurance claims delayed and denied, Human stories hidden, Susan Kristoff fought cancer and insurance injustice, Did Kristoff’s struggles with insurance lead to early death?
“Insurance company mandated dispute resolution, appeal, mediation and arbitration, keeps disputes out of the light of day and creates more delays. It benefits the insurers.”…Citizen Wells
“The secret of life is honesty and fair dealing. If you can fake that you’ve got it made.”…Groucho Marx
“Our right to our day in court has been severely eroded.”…Citizen Wells
Susan Kristoff fought cancer and insurance injustice and passed away in 2014.
I am still fighting insurance injustice.
I believe it is my duty to continue writing and expose the injustice.
From the Susan Kristoff obituary.
“Susan was a wonderful daughter, mother, sister and friend. She loved spending time with her family, searching for antiques, and enjoying time on the ocean in South Florida. She loved roller blading and biking in the beautiful Florida sunshine. She was a certified gemologist, extremely knowledgeable in both modern and antique jewelry. Searching consignment shops, auctions and yard sales for treasures was a particular passion. She always had kind and encouraging words to say to those around her. After being diagnosed with cancer in 2003, there were many difficult challenges for Susan, but she still found reasons to smile and to be positive. She had a hilarious sense of humor, with an infectious laugh, and a smile that could light up a room. She used her long battle with cancer to help others by assuming Leadership roles in organizations such as the Komen Foundation, and South Florida Cancer Society working aggressively to find a cure. Susan actively worked to implement legislative changes to Florida insurance laws. Her efforts helped to pass the Oral Chemotherapy Bill, legislation that made the pill form of chemotherapy a covered medical expense and available to those Florida residents in need. Susan’s advocacy has saved the lives of so many and has provided a higher quality of life for countless others. Susan appeared on Good Morning America twice and on several local news channels speaking about injustices within the insurance industry, her battle with cancer, and the Oral Chemo bill. She was also interviewed for multiple newspaper publications such as the Palm Beach Post and the Baltimore Sun,. She was honored by Komen Foundation as “A Warrior in Pink”. Susan was able to relate the concerns of people with cancer by bringing real experiences and issues to the forefront in order to facilitate change. With her warm engaging personality, she was a tremendous spokesperson for insurance reform and cancer research. She was actively engaged in this fight until just weeks before passing. Most of all, Susan was an amazing and dedicated mother. Susan considered her greatest achievement her son Joshua and always said he was the light of her life. She beamed with pride when speaking about Joshua. Susan was known for her passion, empathy, and kindness. She always put the needs of others before her own. Susan’s struggle with Cancer has come to an end and she is in a better place now.”
From ABC News April 25, 2008.
“GMA Gets Answers: Insurer Delays Long-Term Benefit Coverage
To see Susan Kristoff relaxing near her home in West Palm Beach, it’s hard to imagine she has been fighting two very difficult battles.
One is against a potentially deadly form of breast cancer. Her other battle has been against her insurance company.
“I’ve moved twice, but I still have a place to live. But if it wasn’t for my family, I wouldn’t,” Kristoff told “Good Morning America.”
Kristoff was working at Yellow Book selling advertising 1½ years ago. The job entailed lugging the heavy books to meetings with potential clients. It was a job she loved, until one day a visit to the doctor brought terrible news.
She was diagnosed with stage 4 metastatic breast cancer, and it was spreading throughout her body.
“It was awful, and I was extremely tired — limping, sharp pain,” Kristoff said.
Doctors said there was no way she could do her sales job anymore. The cancer had actually eaten holes through her hips. Her company had no other position to offer her, so Kristoff filed a claim for disability insurance.
Like millions of Americans, she paid a small amount each month — $20 in her case — to cover her financially should she be unable to work. One-third of Americans have some form of disability insurance.
For Kristoff, paying Cigna for disability insurance was the easy part. Collecting the insurance was a different story.
“It was a daily, eight-hour job just trying to fulfill the information that Cigna was requesting,” she said. “And it wasn’t once. It would be over and over again.”
But after five months of submitting forms, Cigna denied Kristoff’s claim for short-term disability. Cigna said she had not proven a disability. Sick and with bills piled up, Kristoff says she considered something drastic.
“If I wasn’t going to be getting better, I didn’t want to sink the rest of my family, so I spent two days in bed crying and thinking about suicide,” she said.
Instead Kristoff hired an attorney. In short order, Cigna reversed course and paid her short-term benefits. Then with her lawyer’s help, she applied for the much more important long-term help.
Her policy promised to pay her 60 percent of her salary if she was too disabled to work.
This time Cigna raised a different objection, saying because Kristoff had a different form of cancer two years before she was diagnosed with the breast cancer that had metastasized, she did not qualify for disability. Doctors say the two cancers are unrelated, and she had been diagnosed as cancer-free well before she began her new job.
“I’m appalled, I’m disgusted, but I’m not surprised because there are hundreds of Susans, many of which I’m representing currently,” said Kristoff’s attorney, Alicia Paulino Grisham.
Grisham says she’s seen this tactic before and it’s called “slow walking.”
“The insurance companies understand that if they deny and deny claims, then many of the claimants will never pursue their claim,” Grisham said.
Law professor and former White House staffer Sara Rosenbaum agrees. She says federal law protects insurers from costly punitive damages from consumer lawsuits, giving them an incentive to delay.”
“Finally, Some Good News
“GMA” got involved in Kristoff’s case as she was awaiting the results of yet another appeal.
It had been 1½ years since her cancer diagnosis, but shortly after “GMA” called Cigna on her behalf, Kristoff got some good news.
Cigna announced that based on “additional information … her disability benefits would be covered ” after all.”
“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.”
At its best, the appeal process is controlled by the insurer, out of the light of day (courtroom). It also delays resolution and the insured getting critical monetary help, often when the help is most needed.
People who are fighting disabilities, pain, cancer or whatever ailment, are in no position physically, emotionally or monetarily to be put through these ordeals.
I have experienced this first hand.
In many cases it is difficult to get legal representation because many attorneys will not touch cases with mandated dispute resolution.
From long time Citizen Wells commenter oldsailor:
“I was unable to find a lawyer anywhere who would help her re negotiate her claim. All the lawyers told her that MANDATED ARBITRATION is really designed to protect INSURANCE COMPANIES from excessive losses. They don’t give a damn about the victim.!!!!”
Did the delay and deny tactics of CIGNA cause the early death of Susan Kristoff?
They sure didn’t help.