“Throughout the debate, Senate Republicans have argued that this misguided law represents an unprecedented and unconstitutional expansion of the federal government into the daily lives of every American. Most Americans agree. In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same.”
Government approved health insurance? In 2014 it will be a mandate to buy insurance from private companies who pay to finance your campaigns, Senator. The government has given a gift to the private companies with this mandate rather than setting up a government run program, like Medicare, to give them some competition. What’s the solution–private health insurance or a government run program like Medicare for Everyone?
MCCONNELL: Well, it doesn’t make any difference frankly whether you opt-in or you opt-out, it’s still a government plan. You know, Medicaid, the program for the poor now, states can opt-out of that, but none of them have. I think if you have any kind of government insurance program, you’re going to be stuck with it and it will lead us in the direction of the European style, you know, sort of British-style, single payer, government run system. And those systems are known for delays, denial of care and, you know, if your particular malady doesn’t fit the government regulation, you don’t get the medication.
MILLER: Right.
MCCONNELL: And it may cost you your life. I mean, we don’t want to go down that path.
No, of course there are no delays or denial of care now, Senator McConnell because we only have 45,000 Americans die each year due to lack of health insurance, so a public program that would cover everyone would lead to–coverage and health care?
Americans..”don’t want is a Washington takeover of health care along the lines of what we’ve already seen with banks, insurance companies, and the auto industry. Americans don’t want a government-run system that puts bureaucrats between patients and doctors.”
The government has taken over the banks? The insurance companies? The auto industry? When did that happen? The only bureaucrats standing between patients and their doctors work for CIGNA, UnitedHealth, WellPoint and all the other health insurance companies.
Senator McConnell enjoys some of the finest government subsidized health care in the world thanks to the United States taxpayers, the Federal Employee Health Benefits Program. Ask the Senator from Kentucky if we should extend that government program to all United States citizens.
Your tax dollars are used to subsidize private health insurance companies.
If you are unfamiliar with Social Security Disability Insurance, here is an excellent primer put out by AARP. SSDI provides protection specifically to qualified U.S. citizens who become disabled and lose their ability to earn an income. We all pay for this through our Social Security taxes. It’s one of the many benefits of being a United States citizen.
When Paul was employed at Fidelity Investments he had a group disability insurance policy with CIGNA. He even purchased extra coverage–to protect our family with 80% of Paul’s income just in case something happened.
But that money was ill-spent as CIGNA lied to deny coverage to a man with Progressive-Relapsing Multiple Sclerosis. This is not unusual behavior for any private insurance company. In fact, it’s exactly what they do.
But first, you must apply for Social Security Disability Insurance.
When Paul was mid-way through with short term disability and it appeared he was getting progressively worse and not better, CIGNA telephoned us to inform us that they were getting his file ready for long term disability. Great, we thought, they are helping us! Isn’t that what they collect a premium each month for? The answer to that is no. They collect a premium each month to make billions.
From the Group Life Market Survey 2009 outlining the sales in disability insurance, you can see group sales disability totaled $1.3 billion at mid-year, with 27 private insurance companies covering 95% of the total market.
After CIGNA denied Paul’s benefits, they telephoned us again. “You must apply for Social Security benefits and send us proof of your application or your long term application with us will be invalid.”
Why does a private insurance corporation demand that you apply for government benefits?
Money, that’s why. If you qualify and receive Social Security Disability Insurance then your insurance company will off-set the amount of money they contractually owe you by the amount of money you will receive from the government. For example, if Paul’s CIGNA policy was to have paid him $5,000 a month and SSDI would give him $2,000 a month, then CIGNA would subtract that amount and only give Paul $3,000 a month. Your tax dollars are used to subsidize private corporations.
Your money is used to fatten the bottom lines of Aetna, AIG Benefit Solutions (that’s how much now in government money for AIG?) CIGNA, Guardian Life, Hartford Life, Mutual of Omaha, Northwest Mutual, Prudential, Sun Life, UnitedHealthcare, Unum and Wellpoint, to name but a few.
Why pay a premium at all?
Why, indeed. The answer is that group long term disability policies are worthless as financial tools. In fact, they are fraudulent products.
How worthless? An entire industry has been set-up surrounding group disability plans to help private insurers NOT pay the claim.
For example, every year the American Conference Institute (one among many) has a yearly event titled, “Litigating Disability Insurance Claims.” Please click the link and read the brochure–it is so very eye-opening. From the brochure, here is what the insurance companies, their general counsels, federal judges (they are the very same federal judges who will decide your disability case!) and doctors will discuss at the above-mentioned conference, emphasis in blue is mine:
- Whether the medical record is reliable: Whether the treating physician is biased and favors the patient (wow, favoring the patient with medical facts?)
- Providing the credentials of the IME’s (Independent Medical Examiner–hired by insurance company): Identifying what is relevant; Highlighting the appropriate credentials; Ways to appropriately critique the credentials of the IME: what to look for and ways to address the inadequacies; Whether specialized medical knowledge is a necessary component of the IME’s credentials (in the case of Multiple Sclerosis, patients are seen and treated by neurologists, the IME who looked at Paul’s written medical records was not a neurologist and first letter of denial was written by an RN and not a doctor)
- Rotating vendors to avoid the appearance of bias and to ensure an independent review of the claim
- The denial factor: How many claims were reviewed and denied?; Whether repetitive denial leads to an appearance of bias; Ways to utilize claim denial information
- Whether the claimant is constrained by financial pressures and returns to work disabled
The last one is of particular interest to me because that is exactly what happened to this family. This family, faced with zero income as Paul had been the sole bread winner for most of our married lives, had to return to work at Fidelity Investments, disabled. This is something the insurance company counts on to help bolster their claim that you are not disabled.
Medical evidence that you are disabled will not prevail.
This conference, and others like it, focus on how to prevent paying a claim, and it does not matter if the claim is legitimate, what matters is the corporate bottom line. The American Conference Institute also has another conference dedicated to defending ERISA claims attended by more federal judges–the very same ones who will hear your ERISA disability case.
Your premium dollars, the ones you work so very hard to pay each month to your private insurance carrier, are spent NOT on paying a claim should you wake up one day with cancer, MS or become injured in an accident. No. Those hard earned dollars are spent on figuring out how not to pay you. And then, they use your tax dollars to reduce the amount they owe you.
United States taxpayers, it’s time to say enough. Group long-term disability policies are bogus products. They should either be highly regulated or not allowed to be sold at all, as the poorly written policies and the attendant machines put in place by the insurance companies to deny all claims is simply fraud.
Call or write your Congressman or woman and tell them you demand consumer regulation of this industry. Better yet, stop paying your premiums immediately.
Links:
CIGNA written brochure for brokers about their long term disability product.
Dell and Schaefer, a law firm, discussing CIGNA including the LINA settlement in California.
The Sarkisyan family confronting CIGNA after the death of their daughter, Nataline. CIGNA refused to pay for Nataline’s liver transplant.
At MS Activism and at Illness and Insurance Hell, I have written extensively about long term disability insurance policies. If the plans are group plans, they are worthless for you the consumer. As a means for making billions for the insurance companies, they are stellar.
Here is a link to the 2009 U.S. Group Disability Mid-Year Market Survey Summary of Results. On page 5 of this survey you will see that with 27 insurance carriers reporting, that is 95% of the group disability insurance market! They have a strong hold on the market and on making sure that claims are never paid out.
And if you have a group disability plan and you have Multiple Sclerosis, this is particularly dangerous since those with MS suffer from an incurable and expensive disease. Your group LTD plan will fight to NOT have to pay your claim should you become too ill to work.
They also do something else: Offset your plan benefits with other “sources” of income, with sources being open to interpretation under ERISA and the judge listening to the case. Which brings me to Judge Steven Colloton.
If you, the MS sufferer, do not have other sources of income for your disability, they will force you to apply for them. They will force you to apply for Social Security Disability benefits or they will deny your claim. That is what CIGNA told this family in 2008.
You know what else these fine upstanding corporate citizens do? They try NOT to pay their contractual obligations by offsetting disability payments through Veteran’s Benefits. I present to you Riley v. Sun Life and Health Insurance Company. Their “leadership” page is here.
Mr. Riley has Multiple Sclerosis and his group plan, Sun Life, did not want to pay him the full benefit amount because he receives Veteran’s Benefits. Sun Life, using ERISA, deducted the amount they agreed to pay him through his group LTD policy by the amount he receives for being a veteran of these United States.
Riley is a veteran of the Vietnam War and receives monthly disability benefits pursuant to the Veterans’ Benefits Act, 38 U.S.C. §§ 101 et seq., (VBA) as a result of his MS. The administrative record indicates that Riley’s MS is considered a service-related disability contracted during a period of war.1 In 2007, in the process of updating Riley’s records, Riley completed a supplemental questionnaire from Sun Life disclosing his receipt of these VA benefits. After gaining this knowledge, Sun Life took the position that it was entitled to offset the amount that Riley received in VA benefits. The Plan provides that monthly disability payments can be reduced by “other income,” and, as relevant and relied upon by Sun Life, the Plan defines “other income” as “[a]ny amount of disability or retirement benefits under: a) the United States Social Security Act [SSA] . . .; b) the Railroad Retirement Act [RRA]; c) any other similar act or law provided in any jurisdiction.” Sun Life recalculated Riley’s benefits offsetting his VA benefits and claimed a net overpayment of $20,831.06 for the years that Riley received both VA and Plan benefits without offset.
Two of the judges of the Eighth Circuit sided with Mr. Riley. One did not. Judge Steven Colloton dissented.
Judge Steven Colloton dissented and sided with Sun Life thereby wanting to put into the hands of a corporation money contractually owed Mr. Riley by the amount deducted from the taxpayers of these United States for taking care of our veterans.
Judge Colloton was appointed to the Eighth Circuit in 2003 by George W. Bush and is now on the Multiple Sclerosis Activism Foundation’s Watchlist.
In what can only be described as Fascist, strong-arm tactics, two GOP congressmen have resorted to putting their constituents (that’s us, their employers) on watch lists for asking tough questions. The tough questions these voters asked had to do with tax breaks for the wealthy and the Republican budget, specifically the Ryan plan to abolish Medicare.
The two freshmen congressmen who have handed out printed “Watch Lists” are Daniel Webster from Florida and Tim Griffin from Arkansas. Rep. Webster’s contact information is here, but he is very shy about wanting to receive any correspondence from anyone other than his constituents. (You see the irony, I hope.)
Rep. Griffin’s contact information is here. More on Griffin’s behavior here at Blue Arkansas.
This is being reported via Think Progress dot org:
Now two Republican freshmen, Reps. Daniel Webster (R-FL) and Tim Griffin (R-AR), are taking this trend one step further, using disturbing intimidation tactics and “watch lists” to discourage constituents from asking them questions:
Rep. Webster’s Winter Garden, Florida district office gave out a “Watch List” of six Floridians who had asked questions at Webster’s previous town halls. The list, with the header “For the Media,” included names, photographs, and questions that members of the media should ask them.
The Watch List itself doesn’t contain any information on who wrote it or where it comes from.The memos surfaced in Arkansas in connection to the office of Rep. Tim Griffin, and were traced back to Rep. Webster’s office.
With black and white photos that resemble police surveillance, some of them pulled from the individuals’ Facebook profiles, the memo is clearly meant to intimidate these six people and anyone else who might stand up and ask a question of their elected representative. At a Griffin town hall, staffers were handing out the Watch List to attendees, calling it their “homework.” Griffin staffers were also spotted taking photos and shooting video of attendees, creating an extra layer of intimidation.
I say it’s time to put Rep. Webster and Rep. Griffin on a Watch List as well. They are, after all, public servants.
They swore an oath to uphold the Constitution of the United States.
They asked to be voted into office to serve, us, their constituents.
They receive their salary from our taxpayer dollars. And they receive subsidized health care from the federal government.
And because they are public servants, a watch list is in order.
This Watch List will keep tabs on all of Congress, Democratic and Republican members who vote to undermine the public health of Americans. By that this Foundation means any member who votes to:
- Abolish or privatize Medicare,
- Abolish or privatize Social Security,
- Harm the public health in any way by voting to defund, deregulate or put a stranglehold on any legislation that helps promote the general well-being and health of citizens of the United States.
The Watch List by the Multiple Sclerosis Activism Foundation includes:
Call to action.
Write your members of Congress, let them know you are disturbed by the actions taken by these two members of Congress and that they need to be censured immediately for their behavior.
House contact information.
Senate contact information.
All federal contact information.
