Cigna Disability Denial Video Transcript

[GRAPHIC: GMA Gets Answers]

DIANE SAWYER: A woman was diagnosed with cancer, denied insurance benefits for more than a year. How could it happen? Can it be changed? Chris got into this story. Chris?

CHRIS CUOMO: Now, Diane, most of us are familiar with health insurance, but disability insurance is another matter. It could be incredibly important. If you get hurt at work, disability insurance is how you keep your family eating and getting gas for your car until you're ready to go back. But disability is run very differently from medical. And as you're about to see, sometimes that works against a person in need.

To see Susan Kristoff relaxing near her home in West Palm Beach, Florida, it's hard to imagine she's been fighting two very difficult battles.

[GRAPHIC: Woman with dog]

CHRIS CUOMO: One is against a potentially deadly form of breast cancer. The other against her insurance company.

SUSAN KRISTOFF: I've moved twice, but I still have a place to live. But if it wasn't for my family, I wouldn't.

CHRIS CUOMO: Two and a half years ago, Susan was working at Yellow Book selling advertising.

[GRAPHIC: Yellow Book phone books]

CHRIS CUOMO: The job entailed lugging the heavy books to meetings with potential clients.

[GRAPHIC: Susan Kristoff]

CHRIS CUOMO: It was a job she loved, until one day a visit to the doctor brought terrible news.

[GRAPHIC: Medical diagram]

CHRIS CUOMO: Stage 4 metastatic breast cancer was spreading throughout her body.

SUSAN KRISTOFF: It was awful and I was extremely tired, limping, sharp pain.

CHRIS CUOMO: Doctors said there was no way she could do her sales job anymore.

[GRAPHIC: Medical diagram]

CHRIS CUOMO: The cancer had actually eaten holes through her hips. Her company had no other position to offer her, so Susan filed a claim for disability insurance.

[GRAPHIC: Earnings statement]

CHRIS CUOMO: 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. But for Susan, paying Cigna for disability insurance was the easy part. Collecting was a different story.

SUSAN KRISTOFF: It was a daily, eight-hour job just trying to fulfill the information that Cigna was requesting. And it wasn't once. It would be over and over again.

[GRAPHIC: Insurance forms]

CHRIS CUOMO: After five months of submitting forms, Cigna denied Susan's claim for short-term disability. Cigna said she had not proven a disability.

[GRAPHIC: Susan Kristoff]

CHRIS CUOMO: Sick and with bills piling up, Susan says she considered something drastic

SUSAN KRISTOFF: 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 I thought about suicide.

CHRIS CUOMO: Thankfully, Susan hired an attorney instead. In short order, Cigna reversed course and paid her short-term benefits. Then Susan applied for the much more important long-term help.

[GRAPHIC: Long-term disability]

CHRIS CUOMO: Her policy promised to pay her 60% of her salary if she was too disabled to work.

[GRAPHIC: Cigna]

CHRIS CUOMO: This time Cigna raised a different objection.

[GRAPHIC: Susan on horse]

CHRIS CUOMO: Saying because Susan had a different form of cancer years before she didn't qualify for disability.

[GRAPHIC: Susan with friends]

CHRIS CUOMO: Even though doctors say two cancers are unrelated, and she had been diagnosed as cancer-free well before she began her new job.

ALICIA PAULINO-GRISHAM: I'm appalled, I'm disgusted, but I'm not surprised because there are hundreds of Susans, many of which I'm representing currently.

CHRIS CUOMO: Alicia Paulino-Grisham says she's seen this tactic before. It's called "slow walking."

ALICIA PAULINO-GRISHAM: The insurance companies understand that if they deny and deny claims, then many of the claimants will never pursue their claim.

CHRIS CUOMO: Law professor and former White House staffer Sara Rosenbaum agrees.

[GRAPHIC: Public law]

CHRIS CUOMO: And she says federal law insulates group disability insurers from costly punitive damages in consumer lawsuits, giving them a big incentive to delay.

SARA ROSENBAUM: Where consumers get their disability benefits through an employer benefit plan, they are virtually powerless against a disability insurance company.

[GRAPHIC: Cigna]

CHRIS CUOMO: We asked Cigna to talk about Susan's case, but they refused. Instead, they referred us to Susan Pisano, representative of the insurance company trade group.

SUSAN PISANO: Our community has every incentive to continue to get better and that's what we strive for.

CHRIS CUOMO: What is the incentive for the insurance company to do things quickly when there is no penalty for doing things slowly?

SUSAN PISANO: You've set up punitive damages as the sort of Holy Grail.

CHRIS CUOMO: That's why we created them because it will teach you not to delay because there may be a price at the end of the road.

SUSAN PISANO: The people who wrote the law wanted to be encouraging employers to offer these benefits. And they did not want to build in a costly and protracted, you know, court situation.

CHRIS CUOMO: Delay tactics are a killer in this situation. How do I pay for gas? How do I pay for food? Where's my day-to-day money?

SUSAN PISANO: The people who framed this law tried to strike a balance, giving every opportunity to make the case, every opportunity for there to be a fair and thorough review.

CHRIS CUOMO: When we met Susan, she was awaiting the results of yet another appeal. It's been a year and a half since her diagnosis. So GMA started making calls to Cigna. And soon after that, Susan got some good news.

ALICIA PAULINO-GRISHAM: Congratulations.

[GRAPHIC: Additional information]

CHRIS CUOMO: Cigna announced that based on additional information, that her disability benefits should be covered after all. We were, of course, curious as to what new information had changed Cigna's mind, but they refused to comment.

ALICIA PAULINO-GRISHAM: The only thing that changed in this case was that "Good Morning America" started calling Cigna. And they knew that there was a good chance that their normal insurance delay tactics would be exposed.

[GRAPHIC: Medical diagram]

SUSAN KRISTOFF: The insurance companies know if they just ask for more information and more information and more information, a lot of times the people don't make it.

CHRIS CUOMO: No, as you can see, Susan is looking good. She received an experimental cancer vaccine in late 2006 and since her health is much improved. Not enough for her to go back to work, but she is out of the woods with her cancer for now.

We also learned that Susan actually received a check from Cigna for the long-term disability. So she's go the money to survive while she's trying to get fully healthy.

DIANE SAWYER: So she did get that check.

CHRIS CUOMO: She's got the money, but a lot of others out there need the help.

DIANE SAWYER: All right. And we want to thank our station, KOCO in Oklahoma City for their help with this story.

CHRIS CUOMO: Oh yeah.

DIANE SAWYER: And also, if you have something that you'd like Chris to investigate, go to ABCNews.com and send us an email.

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