Depression Claim Video Transcript

[GRAPHIC: Healing Our Healthcare]

RICHARD FRENCH: Welcome back. What do you do when you're really sick? Naturally, you're going to turn to your doctor and to your insurance provider if you're fortunate enough to have health insurance. But what if those two disagree? Fighting a disease while battling bureaucracy is to much for many to take. Karen rejoins us now with more.

KAREN DEPODWIN: Well, Rich, when your doctor says you can't work, but your insurance company won't cover disability, what next? Sick people across the country are fighting for the care and assistance their doctors say they need.

A woman in Florida battling breast cancer couldn't go back to work lugging heavy books in her sales job. But when Cigna denied her disability claim, she thought there was no way out.

[GRAPHIC: "If I wasn't going to be getting better, I didn't want to sink the rest of the family, so I spent two days in bed crying and thinking about suicide." Susan Kristoff Source: ABC News]

KAREN DEPODWIN: Telling ABC News, "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 thinking about suicide." After her story became public, her claim was eventually approved. But Susan Kristoff is not alone. Many others are fighting similar battles, others like James Gonzalez. James Gonzalez is sick, according to his doctors. But his illness is one you can't see.

JAMES GONZALEZ: Some people think when you're ill you need a cast or a wheelchair. You know, those are severe illnesses. But, you know, depression its, it's internal. And it's serious.

KAREN DEPODWIN: Pills are part of a daily regimen for James Gonzalez in his battle with depression. Multiple doctors said he can't work. At one point, he thought about going back but he says his employer's doctor said he would be a danger to others if he returned to his job as a crew chief at American Airlines.

[GRAPHIC: Employee badge]

KAREN DEPODWIN: But his insurance company disagreed. Cigna denied his claim for disability. This is actually the second time he's applied. Another bout of depression forced him to leave work in 2000. His claim was then approved. Since then, he ended up in the hospital with what he thought was a heart attack. Now his doctors say his condition has worsened and Gonzalez is now having panic attacks. He says so much has happened over the past few years, from a divorce to a traumatic incident involving a family member.

JAMES GONZALEZ: I was, it was, you know it's been very hard to accept and it was a major blow to me.

KAREN DEPODWIN: He left work in September of 2007 and will be reevaluated this October. In the meantime, while he's struggling with his illness, his finances have hit rock bottom.

JAMES GONZALEZ: I'm going through a divorce. I've lost my car. I've lost, I lost my personal belongings. I, I, I'm 1,000 miles away from my children. I, I, it's just--so much have happened in the last seven months that it's, it's, it's been a journey, it's been a very long journey for me.

KAREN DEPODWIN: Gonzalez hasn't hugged his children in over six months. He sold everything he had to keep up with his child support payments. He told me when he was healthier and working at American Airlines, he made over $100,000 a year. Now moving in with his step brother was his only option. He lives in New Jersey, takes a bus to see his doctors and sleeps on a mattress on the floor.

JAMES GONZALEZ: I live with my step brother who's, he's been very supportive, he's been very helpful. And we're going through tough times together 'cause, you know, everything is tough now. It's not only me, it's the economy and everything else, so everybody's trying to work together to, to survive.

KAREN DEPODWIN: Gonzalez remembers vividly being approached in the break room of his job with a suggestion of disability insurance. His union, Transfer Workers Union, was backing it up and Mr. Gonzalez and others signed on the dotted line. They watched as their money was pulled out of their paychecks.

JAMES GONZALEZ: In case you ever get ill or need assistance with your pay or something that they would guarantee half your paycheck to get through the tough times.

[GRAPHIC: Claim Denied Cigna says Gonzalez's claim lacked objective evidence of disability]

KAREN DEPODWIN: Cigna denied the claim because of what they called a lack of objective evidence of disability.

[GRAPHIC: Cigna Statement "Claim decisions are based on the medical information we receive. This information must be at a sufficient level of detail... Sometimes, despite multiple attempts and our best efforts, we do not receive this...]

KAREN DEPODWIN: A Cigna spokesperson released a statement to RNN that reads in part, "Claim decisions are based on the medical information we receive. This information must be at a sufficient level of detail. Sometimes, despite multiple attempts and our best efforts, we do not receive this information.

[GRAPHIC: Cigna Statement ...information, which means we do not have information to confirm...his or her limitations and restrictions..."]

KAREN DEPODWIN: Which means we do not have information to confirm his or her limitations and restrictions." Unable to return to work and unable to afford life without financial assistance, James Gonzalez is seeking help. Maggie Smith is an insurance lawyer based in Florida. She argues there was more than enough evidence included in Gonzalez's claim.

MAGGIE SMITH: And also, American Airlines' own doctor advising him not to return to work because it's unsafe for him to work around airplanes, it's unsafe for him and for the crew members that he was responsible for supervising as crew chief.

[GRAPHIC: Disability Claims Smith Claims: Depression is Number 1 Reason for Filing]

KAREN DEPODWIN: Smith says disability claims filed because of depression tops the list, but it is often the toughest to process.

MAGGIE SMITH: Unfortunately, you see a way of thinking by insurance companies that sort of dates back to the 1950s when there was discrimination against the mentally ill.

[GRAPHIC: Cigna's Response Won't comment because of privacy laws]

KAREN DEPODWIN: Because of privacy laws, the insurance company won't comment on specific claims.

[GRAPHIC: Covers 4 million people Helped more than 180 thousand on disability last year Fair appeal process]

KAREN DEPODWIN: A spokesperson pointed out that Cigna covers 4 million people under disability plans and helped more than 180,000 people last year. Adding that if an individual disagrees with any decision, Cigna will give all due consideration to an appeal.

Maggie Smith and James Gonzalez are in the process of filing that appeal. In the meantime, he'll continue his financial and medical battles. Rich?

RICHARD FRENCH: You know, I'll be honest, before I saw the piece, I wouldn't put depression and disability in the same sentence. But when you think about it, it's got to be very difficult to do one's job when you're suffering from depression.

KAREN DEPODWIN: Well especially when you're managing other people like James Gonzalez was. His lawyer, Maggie Smith, said this is something that affects his cognitive ability to focus and to manage these crew members that he was working with under American Airlines. And he was managing people's baggage and, you know, putting it on planes and telling it where to go. So you could imagine, if somebody wasn't focusing in that capacity what could happen.

RICHARD FRENCH: I can, I can imagine very easily if you travel the bag doesn't get there. Now, speaking of Mr. Gonzalez, what's next for him?

KAREN DEPODWIN: Well, like I said, he's working on his appeal with his attorney and he's hoping to visit his children, his four children that he hasn't seen in seven months.

RICHARD FRENCH: Thank you very much, Karen, I appreciate it.

[GRAPHIC: Online Poll Do you have faith in your health insurer? Yes, a great deal: Somewhat: Not at all: Vote at www.RNNTV.com]

RICHARD FRENCH: And that all brings us to our online poll question tonight. As we said the subject that many of you at home I bet can relate. Do you have faith in your health insurer? Now please vote. Just go to RNNTV.com. We're going to have the results coming up shortly.