Category Archives: Arbitration

Case against Thrivent, NAIC  why arbitration clauses should be banned, If arbitration benefits members why mandate?, Erickson vs Thrivent

Case against Thrivent, NAIC  why arbitration clauses should be banned, If arbitration benefits members why mandate?, Erickson vs Thrivent

“Thrivent contends that its commitment to individual arbitration is ‘”important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.’”…Thrivent v. Acosta Nov. 3, 2017

“pre-dispute mandatory arbitration provisions are inappropriate in insurance policies and incompatible with the legal duties insurers owe policyholders when handling their claims.”…NAIC, National Association of Insurance Commissioners, August 15, 2016

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

 

From Erickson vs Thrivent.

“This case involves an insurance contract between Plaintiff Raymond Erickson and a fraternal benefit society. Insurance contracts issued by a fraternal benefit society generally include the society’s bylaws, as well as any subsequent amendments to the bylaws, provided that the amendments do not reduce the benefits promised in the original contract. This Court must decide whether Erickson is bound by an arbitration clause that was not in his original insurance
contract but was later added to the fraternal benefit society’s bylaws. Because the arbitration clause does not reduce Erickson’s benefits under the contract, this Court finds that the clause applies to him and requires him to arbitrate his claims.”

“Erickson made a claim for benefits under the contract. in December 2014 after he moved into a long-term care facility. Doc. 1 at 13. Thrivent paid Erickson benefits for some time, but terminated them in November 2015. Doc. 1 at 16, 18. Erickson then sued Thrivent in this Court, asserting claims for breach of contract, bad faith, breach of fiduciary duty, punitive damages, and attorney’s fees. Doc. 1. The parties mediated before Magistrate Judge Veronica Duffy, but were unable to resolve their dispute. Doc. 11. Thereafter, Thrivent filed a Motion to Compel Arbitration and argued that the Federal Arbitration Act (FAA), 9 U.S.C. §§ 1-14, and the Dispute Resolution Bylaw require this Court to stay the case and compel arbitration. Docs. 14, 15, 21. Erickson opposed the motion, contending that the Dispute Resolution Bylaw is unenforceable for several reasons.”

“State contract law governs whether a valid arbitration agreement exists between Erickson and Thrivent. First Options of Chi .. Inc. v. Kaplan, 514 U.S. 938, 944 (1995). This Court is sitting in diversity jurisdiction, so it applies South Dakota’s choice-of-law rules to determine which state’s laws govern whether a valid arbitration agreement exists. Dakota Foundry, 891 F. Supp. 2d at 1095. The parties disagree on which state’s law should apply, with Thrivent arguing
for Wisconsin law and Erickson arguing for South Dakota law.”

“The issue of which state’s law applies does not raise a material question of fact because the Dispute Resolution Bylaw constitutes a valid arbitration agreement under Minnesota, South Dakota, and Wisconsin law. Minnesota, South Dakota, and Wisconsin have all enacted statutes regulating fraternal benefit societies. Minn. Stat.§§ 64B.Ol–64B.48; SDCL §§ 58-37A-1 to 58-37A-39; Wis. Stat. §§ 614.01–614.96, 632.93. Under these laws, a fraternal benefit society
insurance contract consists of the insurance certificate, the member’s application, and the laws of the society. Minn. Stat. § 64B.19; SDCL § 58-37A-19; Wis. Stat. § 632.93. Critically, Minnesota, South Dakota, and Wisconsin statutes recognize that contracts between a fraternal benefit society and its members include later amendments to the society’s laws, provided that the
amendments do not destroy or diminish the benefits promised in the original contract. . Minn. Stat.§ 64B.19(2) (“Any changes, additions, or amendments to the laws of the society duly made or enacted subsequent to the issuance of the certificate, shall bind the owner and the beneficiaries, and shall govern and control the benefit contract in all respects the same as though the changes, additions, or amendments had been made prior to and were in force at the time of the application for insurance, except that no change, addition or amendment shall destroy or diminish benefits that the society contracted to give the owner as of the date of issuance.”); SDCL § 58-37-A-19 (“Any changes, additions or amendments to the laws of the society made or enacted after the issuance of the certificate, bind the owner and the beneficiaries, and govern and control the benefit contract in all respects the same as though the changes, additions, or
amendments had been made before and were in force at the time of the application for insurance. However, no change, addition, or amendment may destroy or diminish benefits which the society . contracted to give the owner.as of the date of issuance.”); Wis. Stat. § 632.93(2) (“[A]ny changes in the laws of a fraternal made subsequent to the issuance of a policy or certificate bind the
owner and any beneficiary under the policy or certificate as if they had been in force at the time of the application, so long as they do not destroy or diminish benefits promised in the policy or certificate.”). As required by Minnesota, South Dakota and Wisconsin law, Minn. Stat. § 64B.19; SDCL § 58-37-A-19; Wis. Stat.§ 632.93, Erickson’s contract states that the Articles of Incorporation and Bylaws, including any later amendments, are part of the agreement: ”

Read more:

http://eachstorytold.com/2018/07/15/thrivent-and-fraternal-insurance-why-you-should-not-buy-their-insurance-erickson-vs-thrivent-reveals-all-retroactive-contract-changes-mandated-dispute-resolution-and-arbitration-companies-control/

United Insurance vs Office of Insurance Regulation, State of Florida.

“Section 624.155 is a statute regulating the business of insurance. The statute relates, directly or indirectly, to the relationship between the insurance company and the policyholder. The proposed arbitration agreement would impair, invalidate or supersede section 624.155. The statute provides for a civil action — with the relevant procedural protections. The statute also provides for court costs and fees. Mandatory binding arbitration lacks the procedural and constitutional protections (such as jury and appeal to an Article V court) of a civil action.”

Read more:

http://eachstorytold.com/2018/07/15/florida-insurance-statutes-mandatory-binding-arbitration-lacks-the-procedural-and-constitutional-protections-such-as-jury-and-appeal-united-insurance-company-vs-florida-office-of-insurance/

NAIC: Why arbitration clauses should be banned.

“This judicial recognition that mandatory arbitration provisions can interfere with core state and federal Constitutional rights, and that consumers have not “consented” in any meaningful sense to these clauses, apply equally to insurance consumers. This is demonstrated previously in the memorandum presented at the April 5, 2016 Consumer Liaison Meeting in New Orleans, and further detailed by the consumer group Texas Watch.2 Along with our colleagues, we can provide detailed information on these issues if D Committee wishes.
Today we focus on the claims process. The nature of the insurance promise is different from most other consumer services or products, and pre-dispute mandatory arbitration provisions are inappropriate in insurance policies and incompatible with the legal duties insurers owe policyholders when handling their claims.

  • Companies that include pre-dispute mandatory arbitration clauses in their consumer contracts presumably do so because it will be to their advantage should a dispute later occur.
  •  However, handling claims is an essential element of the insurance contract and insurers are required to consider the best interests of their policyholders. Courts frequently describe this broad duty as requiring “the insurer to consider the interests of its policyholder in a manner at least equal to its own.”3
  • Inserting a pre-dispute mandatory arbitration clause in an insurance policy allows the insurer to select the venue most favorable to it should a dispute later occur and therefore makes it less likely that policyholders will assert their rights to dispute their insurers’ claim evaluations, and less likely they will succeed when they do.
  • Insurers convinced that arbitration will benefit policyholders and insurers equally (or policyholders more), should therefore be willing to provide – and not mandate – arbitration as an option when an actual dispute occurs. If arbitration provides a truly neutral forum, then there is no need for an insurer to insist on its use.”

“Insurers that would insist on mandatory arbitration of policyholder disputes have selected the forum that they believe will be more favorable to them than to their policyholders, if not on each individual claim then in the aggregate. However, manipulating the dispute resolution process in this manner conflicts with the duties insurers owe their policyholders and is not holding their policyholders’ interests “at least equal to their own.”

If arbitration was truly a neutral forum rather than one favoring insurers, then there would be no need for an insurer to insist on its use before a dispute has even arisen. Insurers should utilize arbitration only when the policyholder has consented to do so after an actual dispute occurs (which is what the suggested amendment to the Model Unfair Trade Practices Act should accomplish), rather than requiring it in boilerplate language that the policyholder is very unlikely to read, could not bargain over the provision even if she did, and could not make an
informed decision at the point of sale on the merits. True freedom of contract, combined with the fundamental right to a trial, requires a knowing relinquishment of that right, which can only occur voluntarily once a specific dispute has materialized.”

“Taken together, these decisions deliver two clear messages: (1) States can enforce bans on arbitration provisions in insurance contracts, and (2) the likelihood of surviving a FAA preemption argument is often related to the specificity of the prohibition. Our sample language (below) attempts to maximize the power of McCarran-Ferguson by adding it as an amendment to the Model UTPA, which itself states in Section 1 that “The purpose of this Act is to regulate trade practices in the business of insurance in accordance with the intent of
Congress … [citing McCarran-Ferguson],” and by making the ban directly related to insurance contracts.”

Read more:

http://eachstorytold.com/2018/07/16/naic-banning-arbitration-clauses-in-insurance-policies-why-arbitration-clauses-should-be-banned-companies-that-include-pre-dispute-mandatory-arbitration-clauses-do-so-because-it/

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

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Thrivent Financial for Lutherans v. Colin Brock appeal, Thrivent nonpayment of disability benefits, Order denying Thrivent’s motion to confirm arbitration award, Brock alleges fraud corruption or other undue means

Thrivent Financial for Lutherans v. Colin Brock appeal, Thrivent nonpayment of disability benefits, Order denying Thrivent’s motion to confirm arbitration award, Brock alleges fraud corruption or other undue means

“Thrivent contends that its commitment to individual arbitration is ‘”important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.’”…Thrivent v. Acosta Nov. 3, 2017

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

“Martin Luther may or may not have stated ‘Here I Stand’ but his actions certainly did.”…Citizen Wells

 

From Thrivent Financial for Lutherans v. Colin Brock.

“This interlocutory appeal and original proceeding arise from a dispute between Colin Brock and his insurer, Thrivent Financial for Lutherans (“Thrivent”) over nonpayment of disability benefits, which Brock claims Thrivent owes him under a Thrivent insurance policy.   As required by the policy, the trial court compelled the parties to arbitrate.   Following an evidentiary hearing, the arbitrator denied Brock’s claims.   Thrivent moved the trial court to confirm the arbitration award.   In turn, Brock requested the trial court to vacate the arbitration award on the ground that the award was obtained “by fraud, corruption, or other undue means.”   The trial court signed an order denying Thrivent’s motion to confirm the award, vacating the arbitration award, and directing a rehearing before a new arbitrator.   Thrivent appeals the order and also seeks review by way of a petition for writ of mandamus.   Brock contends that we have no appellate jurisdiction over the interlocutory order and requests that the petition for mandamus be denied.

We dismiss Thrivent’s interlocutory appeal for lack of jurisdiction and deny its petition for writ of mandamus.”

https://caselaw.findlaw.com/tx-court-of-appeals/1108836.html

AAL, Aid Association for Lutherans, implemented a change to their contracts, retroactively in 1999, to impose mandatory dispute resolution consisting of Appeal, Mediation and Arbitration in lieu of litigation. Their member dispute resolution program is referred to as MDRP. They claim, and many courts have upheld that they could implement and enforce the change retroactively due to their fraternal status. This has not been challenged in all states and since the states differ on how insurance entities are treated, this is still an open question.

The embracing of mandatory arbitration has become widespread in consumer and employment contracts. This has led to a huge impact on our day in court and given companies much power to control outcomes and continue unsavory practices, harmful to consumers.

This is not just a Thrivent problem or insurance problem, it is a problem affecting the daily lives of all Americans. Thrivent’s practice of using their special status is particularly unjust and alarming and runs contrary to their platitudes touted in company policies.

Thrivent v. Brock revelations and questions.
  • Brock alleges: “the award was obtained ‘by fraud, corruption, or other undue means.’”  We have no way of knowing because the MDRP, culminating in arbitration, was held behind closed doors, out of the light of day of a courtroom.
  • Brock had taken the arbitration decision to trial court and next the appeals court. How much were the legal fees?
  • Thrivent has a large legal staff and engages outside legal firms who specialize in disability cases.
  • How much time elapsed from the first disability claim to the appeals court decision and probable redo of arbitration?
  • What happened next? Arbitration? What was the outcome.
  • What is Colin Brock’s disability? Is it life threatening or painful? Is Mr. Brock getting adequate treatment?
  • Was Mr. Brock able to pay his bills? Feed a family?
  • How has the MDRP process helped Mr. Brock? Did he experience the blessings of the Christian beliefs touted by Thrivent?
  • How many Thrivent members drop out of this MDRP process for various reasons such as too engulfed in pain and stress or discouraged by improper Thrivent procedures and attitudes? Mr. George Tiedemann went through the process for 2 years and dropped out. He was 83.
  • How many Thrivent members were shocked to find out that the policy they took out years earlier, had been modified without their consent or signature?
  • How many Thrivent members sought legal representation to no avail because many attorneys will not touch a case with mandated arbitration?

 

“Thrivent’s Christian Calling

Thrivent’s Lutheran heritage of answering God’s call has led to a strong membership-owned organization that now welcomes Christians seeking to live out their faith.

Fraternal benefit societies have a common bond among members. Thrivent’s common bond is Christianity. We embrace the core Christian beliefs as articulated in the Apostles’ Creed as follows:

I believe in God, the Father almighty, maker of heaven and earth.
I believe in Jesus Christ, his only Son, our Lord, who was conceived by the Holy Spirit, born of the virgin Mary, suffered under Pontius Pilate, was crucified, died, and was buried. He descended into hell. The third day he rose again from the dead. He ascended into heaven and is seated at the right hand of God the Father almighty. From there he will come to judge the living and the dead.
I believe in the Holy Spirit, the holy Christian Church, the communion of saints, the forgiveness of sins, the resurrection of the body, and the life everlasting.

If you share these beliefs, we invite you to join other Thrivent members called to pursue a life of generosity and wisdom with money.”

https://www.thrivent.com/about-us/files/28023.pdf

Here I stand.

 

More here:

https://citizenwells.com/

http://citizenwells.net/

Thrivent insurance claims reviews, Dispute resolution program benefits members?,Christian common bond?, “Don’t use this company they hide behind the cross”

Thrivent insurance claims reviews, Dispute resolution program benefits members?, Christian common bond?, “Don’t use this company they hide behind the cross”

“Thrivent contends that its commitment to individual arbitration is “important to the membership because it reflects Thrivent’s Christian Common Bond, helps preserve members’ fraternal relationships, and avoids protracted and adversarial litigation that could undermine Thrivent’s core mission.”…Thrivent v. Acosta Nov. 3, 2017

“The MDRP is the sole means for presenting and resolving grievances, complaints, or disputes between Members, insureds, certificate owners or beneficiaries and Thrivent or Thrivent’s directors, officers, agents and employees. The MDRP reflects Thrivent’s Christian belief system and strives to preserve Members’ fraternal relationship.”…Thrivent vs Perez Sept. 29, 2016

“Beware of false prophets, which come to you in sheep’s clothing, but inwardly they are ravening wolves.”…Matthew 7:15

 

Below are some reviews of Thrivent insurance claims experiences that are similar to my experiences with Thrivent.

January 17, 2017.

“First of all I’m not a insurance company or employee. I have investments, life insurance, and disability insurance with Thrivent. I have been with Thrivent for many years and trusted them. when I became disabled a year ago and could not work I filed my private disability insurance along with my SSDI. After 7 months of waiting my SSDI was approved the 1st time, Still waiting and expecting my private disability insurance to be approved by Thrivent I received a letter from them with a denial stating I could still work according to all the medical records supplied. I supplied letters from my primary doctor and the specialists treating me stating I was disabled and could not work, I sent an e-mail to Thrivent letting them know of my approval for my SSDI and I got a letter back from them stating that there standards for approval are much higher then the Federal Gov. I followed all there requirements supplied all records never had to be evaluated by Thrivent’s doctor. They just flat denied my claim with a stupid excuse. I have been working with a attorney on this claim to try and settle it. Thrivent has been stalling them every step of the way. THIS DISABILITY POLICY IS A SCAMM. They never had any attention on paying out benefits. They communicated during the process with useless letters telling me nothing about my case. and short to the point e-mails telling me nothing. I have had to put out thousands of dollars in attorney fee’s and thousands of dollars in medical treatment fee’s for out of network doctors. If I don’t qualify for there disability benefits I don’t think anyone can. I DIDNT KNOW IT WAS ME AGIANST THRIVENT INSURANCE, THAT IS HOW THEY MAKE YOU FEEL. Don’t use this company they hide behind the cross.”

Read more:

https://insurance.freeadvice.com/reviews/377/comments/Thrivent+Financial/

Nancy Bowman February 6, 2018.

“We had a very difficult time during my husband’s illness, Parkinson’s among others, getting any help from Thrivent. Their customer service people were rude and of no assistance. Of his $170.000 fund, we spent $6,000 due to their outrageous, convoluted rules written for the benefit of the company. The salesman did not explain any of these caveats when we purchased the policy and refused to take my calls. Now I need some help, in-home, due to a broken foot but am told I have to pay for 90days of help before they will begin to pay, then need a doctor’s certification that I am disabled. There is a clause stating that if a licensed Health Care Practitioner has, with a 12 month period preceding that day, (what day?) certifies that the person has a physical impairment to last at least 90 days, but it doesn’t say anything else.I am about to go to my attorney, call my Congressmen and anything else to bring this company around. They keep a client’s fund separately but then, if not used, they abscond with it. It’s our money but they act like it’s theirs. They could keep the interest, but refund the premiums not used. It’s white-collar theft and they get away with it because they are a brotherhood. I would never have done business with this company.”

Cathy February 13, 2018.

“I am working on a long-term care insurance benefit dispute for 9 months now. Thrivent refuses to pay the claim even though my mother is coming to the end of her life and is totally disabled. I received a letter today stating that Thrivent does not have to justify their reasons for not paying the claim.
I attempted to resolve the claim through the Pennsylvania Dept of Insurance who did nothing but recommend we get an attorney. I also Issued a claim with the Better Business Bureau… another complete waste of time. Thrivent pays the BBB to post an A+ rating.
Today I sent my dispute to the Attorney General’s office.
Please… let’s not let this unethical organization take our parent’s money and then hide behind red tape and ambiguity when it is time for a payout. Has anyone contacted the Lutheran Synod to find out who is promoting these crooks? Does the Lutheran Synod know that Thrivent is not paying their claims?”

Kris Boike November 3, 2016.

“After a year of paying out on my mothers Long-Term Nursing Claim, Thrivent has stopped. They continuously change their minds of what they require within the Plan of Care from the Nursing Home. This has been going on for 4-5 months now, with at least 6 different versions of the Nursing Plan of Care being submitted. Not only is this experience frustrating, expensive to now start paying Nursing Home expenses directly, they expect my mother and father to re-start paying the LT Care Premiums while we go through the appeals/Membership Resolution Process. The Claims Examiners lie/change their minds constantly to avoid paying out! Lawyer-Up people! 17 Years of paying premiums and now they want more years of premium payments to avoid paying out! Snakes!”

Read more:

https://www.expertinsurancereviews.com/insurance-company-reviews/thrivent-financial/

I have attempted to contact a Doctor who is seeking others with bad Thrivent experiences. Hopefully he will respond.

 

More here:

https://citizenwells.com/

http://citizenwells.net/

 

 

 

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?

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.”

http://eachstorytold.com/2018/07/07/susan-kristoff-obituary-fought-cancer-and-insurance-injustice-featured-on-good-morning-america-spokesperson-for-insurance-reform-and-cancer-research-wonderful-daughter-mother-sister-and-friend/

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.

Delay Tactics

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.”

Read more:

https://abcnews.go.com/GMA/story?id=4724106&page=1

CIGNA response.

“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.”

https://abcnews.go.com/GMA/story?id=4725972

Fair?

To whom?

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.

 

 

More here:

https://citizenwells.com/

http://citizenwells.net/