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CIGNA Insurance Disability Payment Clawback ERISA Class Action

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Plaintiff Anthony Patchell was a US soldier who served in Bosnia and Iraq. Unfortunately, multiple IED explosions left their mark on his mind and body, and he left the service for medical reasons with a traumatic brain injury and PTSD. Still, he went to work for as an intelligence analyst for a defense contractor Oberlin (later known as Stanley). When he finally became disabled, on February 6, 2010, it was because of failed back syndrome, which involved the permanent fixture of metal plates and rods to his spine for support. A judge ruled him to be totally disabled.

Luckily, his company had a disability policy as a group benefit, governed by ERISA and managed by Cigna or Disability Management Solutions, two of the defendants in this case. You’d think that if anyone deserved to be on disability, Patchell did. And for awhile he was.

Disability payments began late, the complaint alleges, but after six weeks they were suspended by the defendants. With the help of an attorney, Patchell sued, and the benefits were restored, but some of the payment now had to go to pay the attorney. Additional money went to Patchell’s three children by two different mothers.

Then Cigna stopped all money to Patchell because, despite the judge’s ruling, the complaint says, Cigna claimed he was not disabled from all occupations and the company was entitled to his benefits to repay itself for what it had already paid out.

The complaint cites a US Supreme Court case, Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, where the court decided that, even if an ERISA benefit plan wants reimbursement of a participant’s settlement, it cannot take that reimbursement from a participant’s general assets when the settlement has been spent on “non-traceable items” such as food. The complaint asserts that that case is similar to this case, in which Patchell and his children spent the disability payments on living expenses.

Yet the defendants refused to discuss less onerous repayment terms than this clawback repayment of 100% of his benefits.

The class for this action includes

  • All participants or beneficiaries in ERISA plans underwritten or administered by Cigna or any of its operating divisions, including LINA, who, between January 21, 2016 and the present time took an offset against any plan beneficiary; and
  • All participants in ERISA plans underwritten or administered by Cigna or any of its operating divisions, including LINA, who, between January 21, 2016 and the present time, denied any beneficiary a Montanile hearing. 
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