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.
Laid-off workers and aging baby boomers are flooding Social Security’s disability program with benefit claims, pushing the financially strapped system toward the brink of insolvency.
Applications are up nearly 50 percent over a decade ago as people with disabilities lose their jobs and can’t find new ones in an economy that has shed nearly 7 million jobs.
The article goes on to state that Social Security disability may run out by 2017.
Why the Social Security Disability Trust may run out
What the article’s author, Stephen Ohlemacher, left out (due to any number of reasons) is that Social Security disability trust has always been ravaged by claims forced upon it by the private health insurance industry.
We speak from first-hand knowledge.
CIGNA forced Paul to apply for Social Security disability, even though he had a paid policy with CIGNA through his former employer, Fidelity Investments.
If you have disability insurance through your employer and you are forced by illness or accident into the long-term disability program, the very first thing your plan does is FORCE you to go and apply for Social Security benefits.
We then had to send CIGNA proof of our Social Security application or his CIGNA disability would be denied. That’s what CIGNA told my husband in a phone conversation back in 2008. (Little did we know CIGNA had planned on denying his benefits already.)
And if Paul was turned down for Social Security benefits, CIGNA would help him find an attorney who would appeal the case. CIGNA states this (however coyly) on their website, although the use of the word, “guide” needs to be replaced with “forced” and “threatened:”
We’ll guide you through the Social Security claims process. Our Claim Managers will review your claim to determine if you may have the potential to receive Social Security Disability Income benefits. If so, they will refer you to an external company specializing in obtaining Social Security benefits.
Health insurers gaming the system
What we have here are innumerable cases of for-profit corporations gaming the system for their own benefit or their bottom-line.
The reason CIGNA, and others, force their disability claimants to go through the Social Security application process is so they can reduce the benefit amount to the claimant by the amount the federal government will give.
In fact, CIGNA produces this slick bulletin for their brokers outlining all the benefits that Social Security and Medicare will provide to those with debilitating diseases, just so CIGNA won’t have to fulfill their contractual agreement. After all, you did pay them premiums.
Crashing the system and fattening their bottom line with Federal dollars
In the process of forcing people who don’t need Social Security disability to apply, (please see the article from the New York Times below) these behemoth insurance companies are purposely crashing our system to the point where people who do need and do qualify may be left without.
The health insurance industry fought a big battle back in 2009 to prevent all Americans from enjoying a public option; one where they would actually have some competition from a government style health insurance plan, like Medicare.
Corporations like United Health Care, WellPoint, CIGNA, Aetna, and others, used all their lobbying power to prevent YOU, the consumer, from enjoying the benefits of your freely-elected government giving you access to affordable health insurance.
BUT when it comes to their ability to enjoy the benefits of our government, well, that’s just fine and dandy. Actually, it’s the purest form of hypocrisy.
From the New York Times, Insurers Faulted as Overloading Social Security:
The insurers are forcing many people who file disability claims with them to also apply to Social Security — even people who clearly do not qualify for the government program.
The Social Security Administration defines “disabled” much more stringently than the insurers generally do, so it rejects most of the applications, at least initially.
The insurers say that requiring a Social Security assessment is a standard practice and that there is nothing wrong with it.
The policies they sell allow them to coordinate their benefit payments with others to make sure no one is paid twice. Thus, if a disabled person can get benefits from somewhere else — like workers’ compensation, a disability pension or Social Security — the insurance company can reduce the benefit check by that amount.
Call to action
Write your Congressional representatives and let them know you know what is going on with health insurers abusing and gaming our system.
YOU paid into Social Security all your working lives and it’s YOUR money and it’s not for companies like CIGNA, United Health, WellPoint and others to use to reduce your benefits. They take in your dollars for health plans but want you to use Federal dollars when it benefits them. Those Federal dollars are your dollars.
And please write to Congressman Paul Ryan specifically since he knows how Social Security helped him through a difficult time in his life yet he wants to hand our money over to private corporations.
The American Conference Institute assembles a yearly “defending against ERISA claims” conference usually held in New York City. This year’s conference is at the New York Marriott Downtown.
If you have Multiple Sclerosis or any other disease that forced you to fight for your benefits because companies like CIGNA denied (lied about) your illness, then you know all about ERISA or the Employment and Retirement Income Security Act of 1974. Unfortunately, ERISA has had negative consequences. A full explanation, written by an ERISA expert, can be found here.
But you may not know that the very same federal judges who may hear your case attend these conferences where they help coach insurance companies, plan providers and other attorneys on how to defend against ERISA claims. In other words, how to make sure a company like CIGNA doesn’t have to fulfill their contractual obligations and pay your claim. From the conference brochure:
An ERISA Moot Court: Featuring top defense attorneys arguing some of the hottest andmost common issues facing ERISA practitioners today, panels of renowned ERISA juristswill critique arguments, question our litigators and help all attendees understand how tosuccessfully convey their positions to the court.
The federal judges are going to going to participate in a moot court? That’s rich. And our favorite here at the MS Activism Foundation:
Breaking Up Is Hard to Do: A Focus on Severance Plan Litigation including Triggering Events,COBRA Hang-Ups, and the Other Litigation Issues that Arise in Separation Situations.
CIGNA had a big loss this year in CIGNA v. Amara, even though they are spinning it otherwise, so of course, CIGNA’s senior counsel, Christina McNally will be in attendance at the conference.
Fidelity Investments, my husband’s former employer, is listed on the last page as being in attendance as well. I could not find a name though. Last year it was their very own senior counsel, (and Paul’s fellow Boston College alum) Laura Tholen.
Here are the names and districts of all the federal judges who are attending this year’s conference. And here is a link to the PDF of the 2011 conference. If you are fighting for your claim, and see your judge, send them a letter. Tell them that you know what they’re doing and that it certainly does not appear impartial.
Here are the Codes of Conduct for United States Judges and be sure to ask about CANON 3: A JUDGE SHOULD PERFORM THE DUTIES OF THE OFFICE FAIRLY,IMPARTIALLY AND DILIGENTLY.
Hon. Daniel E. Knowles, III U.S. Dist. Ct., E.D. La.
Hon. Morton Denlow U.S. Dist. Ct., N.D. Ill.
Hon. Matthew Kennelly U.S. Dist. Ct., N.D. Ill.
Hon. William S. Duffey, Jr. U.S. Dist. Ct., N.D. Ga.
Hon. Viktor Pohorelsky U.S. Dist. Ct., E.D.N.Y.
Fernando J. Gaitan, Jr. U.S. Dist. Ct., W.D. Mo.
Hon. Timothy C. Batten, Sr.U.S. Dist. Ct., N.D. Ga.
Hon. Robert Jonker U.S. Dist. Ct., W.D. Mo. (I think the American Conference Institute meant MI not MO.)
Hon. Richard G. Stearns U.S. Dist. Ct., D. Mass.
Hon. John Coughenour U.S. Dist. Ct., W.D. Wash.
Hon. Robert B. Collings U.S. Dist. Ct., D. Mass.
Associated Press, 07.11.11, 11:29 AM EDT 
NEW YORK — French drugmaker Sanofi said Monday that its multiple sclerosis drug candidate Lemtrada did not achieve one of its goals in a late-stage clinical trial.
Sanofi said Lemtrada worked better than an older drug, Rebif, in preventing relapses, as patients treated with Lemtrada were 55 percent less likely to experience a relapse in symptoms. However, the drug did not prevent their multiple sclerosis from becoming disabling, as it had in previous studies.
Sanofi also listed the side-effects as headache, rash, fever, nausea, flushing, hives, and chills, leaving out the deaths reported in the clinical trials.
I also was very wary when I read the study and they were touting the drug as being able to prevent disability outright. It was even reported that it may reverse brain damage from MS. Nothing short of a miracle, right? Or a selling point worthy of $20.1 billion?
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