Long Term Disability Law Blog

If CIGNA, or one of its subsidiaries, denies your long term disability claim, you should send a request to CIGNA demanding a copy of its claims manual. You should ask for it by name; CIGNA calls its claims manual "The Book of Operating Knowledge."

On November 14, 2006, we successfully defeated CIGNA's attempt to prevent disclosure of its Book of Operating Knowledge. In the case of Levy v. INA Life Ins. Co. of New York, 2006 U.S. Dist. LEXIS 83060 (S.D.N.Y. Nov. 14, 2006), Judge Gerard E. Lynch denied CIGNA's motion. Judge Lynch explains:

The case for non-disclosure is further undermined by Department of Labor regulations requiring disclosure of procedures employed during claims processing as mandated under section 503 of ERISA. See 29 C.F.R. § § 2560.503-1(g)(1), (h)(2), (i)(5), (j)(5), and (m)(8). Indeed, the Department of Labor "has taken the position that internal rules, guidelines, protocols, or similar criteria would constitute instruments under which a plan is established or operated within the meaning of section 104(b)(4) of ERISA and, as such, must be disclosed to participants and beneficiaries." U.S. Department of Labor, "Frequently Asked Questions about the Benefit Claims Procedure Regulation," C-17, www.dol.gov/ebsa/FAQs/faq_claims_proc_reg.html. These requirements make plain that such claims-handling manuals, whether in whole or piecemeal, are likely to be disseminated widely to plan participants and to litigants challenging benefits denials. Under these circumstances, the effort to protect such materials as confidential is quixotic.

Obtaining CIGNA's Book of Operating Knowledge is often helpful because if CIGNA did not follow its own internal procedures a strong argument could be made that it failed to provide you with a full and fair review.

A claimant suffering from bipolar disorder may bring a lawsuit under a fictitious name in order to preserve his privacy. Riemer & Associates convinced the federal district court in New Jersey to allow our client to serve as the lead plaintiff in a class action, using the name "John Doe" instead of his real name. Our client was very concerned that if he used his real name that he would be stigmatized as having bipolar disorder, causing him embarrassment and preventing him from working in the future. The Court agreed, holding:

"[T]here is substantial public interest in ensuring that cases like the plaintiff's are adjudicated and the rights of mental illness sufferers are represented fairly and without the risk of stigmatization. However, this goal cannot be achieved if litigants suffering from mental illness are chilled from ever reaching the courthouse steps for fear of repercussions that would ensue if their condition was made public."

Doe v. Hartford Life and Accident Ins. Co., 05 Civ. 2512(JLL)(D.N.J. July 14, 2006). Further details of this class action can be found on our website's News page.