CIGNA's claims handling facilities in Dallas handle all levels of appeals. Everyone talks. Any suggestion by Dr. Allen Woolf or Gary Person that each appeal gets a fresh look at every level is sheer nonsense. Good Morning America is sniffing around a very good target in Dallas. I hope the lid is blown off.

that is a fabulous appeal. CIGNA is operating a rouge operation in Dallas. Ten years is a long time to determine someone is disabled only to reverse course after a contract with the employer is terminated. Keep fighting because this case will find it's way into the media. Shame on Cigna management for letting this occur.

Mr. Gary Person is the Manager of the Centralized Claim Team. Whether this case represents a "personal" thing or a "financial" thing is unknown. Our opinion is the claim handling is an "unprofessional" or "unethical" thing and that far to many people are suffering through this abuse of the ERISA fiduciary role. Thanks for the contribution

CIGNA's claim staff must have lost their collective minds on this claimant. Keep posting documents and communication because this case will certainly catch the eye and interest of investigative reporters. The appeal is well written and reads as if the case became a personal thing for Gary Person.

Thetsascam has emailed Dr. Woolf and other executives at CIGNA informing them of the existence of the website and the case. The emails are on the homepage in the most recent update. Thanks for visiting the thetsascam and contributing.

Is Dr. Allen Woolf aware of this case and the website? Can he deny knowlege?

I read the appeal and Cigna's responses. I do not understand how Cigna can legitimately say they adjudicated this claimant's appeal. The first appeal completely destroyed the entire rationale for the denial. Both the IME Physician and the CRC wage and employment findings were discredited. Cigna simply moved the goalposts to an employee of Intracorp and created an even flimsier denial. Rotten to the core.

Cigna must not have any oversight of the claims process or they are paying bonuses based on the financial impact of claims. This is not the way claims are supposed to be handled...ERISA or non-ERISA.

ABC News and Good Morning America certainly should keep the pressure on Cigna and Dr. Allen Woolf. The ERISA disability nightmare is hurting many people and many families.

Cigna sucks!!!!! The minute they lost the contract with the employer they sought denials. There was no revenue coming in to support the claims and there was no employer for the claimant to complain to. Happens all the time.

I read the appeal and the responses from Cigna. This case looks like someone above said "deny no matter what". Dr. Allen Woolf has his work cut out for him if he has been in charge of this type of claim practice. Where are the regulators?

Found your site with a Google search for Allen Woolf "Good Morning America". I was looking for additional commentary on Cigna's response to the GMA investigative report. Dr. Woolf better get his arms around the appeal submitted by the claimant referenced in this site. "Walking Slow" will be the least of his concerns.

Where is Karen Haley RN (texas)? Has she spoken to Dr. Woolf? Has she spoken to GMA? After determining the claimant "unable to work" Cigna claim managers Gary Person and Karol Johnson (with no medical experience) reversed her findings. Dr. Woolf's statement to Good Morning America is not consistent with these actions.

you can not expect a proper transferable skills analysis when the insurer withholds documents.

Amazing!! I have never seen anything like this case. Somebody should write a book. Forget Good Morning America this requires Prime time. The part that simply galls me is the scheduling of the IME three days before the claimant's wife was to give birth.

Kudos to Good Morning America. Their investigative report is extremely important because Cigna can not bury it's indiscretions in the courts. The Court of public opinion is very important. Having cases that have not yet been filed in the Federal System that GMA can explore and question Cigna is imperative. This one appears to have everything Cigna does not want to address.

This Good Morning America story is going to get very interesting. The ABC News staff knows they have Cigna. Cigna is the new Unum. The States usually follow the public outcry.

Can you please post some additional appeal documents and correspondence from CIGNA. After ten years of paying benefits and then denying based on some ex-Unum medical director this case is surreal. This may turn out to be the final nail in CIGNA's prosecution. I do not see how they can defend themselves in the court of public opinion on this. Three TSA's with different conclusions, an IME, a Peer Review, a nurse case managers unequivocal statement.....and this is after ten years of paying. The whole case appears to be irrational and contrary to everything Dr. Woolf said to Good Morning America. Please provide additional documents.

There are certainly some familiar names involved in the case on this site. I can not believe Cigna utilized the opinion of a family practice physician (Robert Anfield) to overrule two orthopaedic surgeons. Equally disturbing is the fact that Dr. Anfield is unlicensed in the State of the claimant . Dr. Wolff's statement on the Good Morning America website does not pass the smell test. I hope GMA keeps after Cigna. This case is deeply troubling.

The Insurance companies assume they can bury people in legal mumbo jumbo. The Good Morning America show exposes Cigna's practices for what they are....deeply flawed and predatorial. Hopefully GMA will take notice of the case on this site and ask Cigna's Dr. Wolff how this case squares with his statement in response to the show. Cigna was late in responding to the appeal, they used in-house doctors to overturn independent physicians and their own Nurse case manager, they disavowed the findings of their own surveillance operation, they had the same supervisor that reviewed the first appeal - review te second appeal ........ an absolute disgrace.

This story needs to be investigated by Good Morning America. There are far too many people suffering through these disturbing claim tactics. Cigna should be ashamed of themselves for the case on this website. One has to ask how they get these doctors and counselors to dance with them. It has to be money.

Thanks for the additional info. I saw your post on ABC news website and had to visit. Cigna is operating a little shop of horrors in their dallas offices.

Need always a revision and education and more information to cover some holes or minimized some problems. ___________________ operator Problem With Drugs or Alcohol? This Drug Rehab has Helped Thousands of Individuals to Recover. http://www.drugrehabcenter.com/

Thank you for the information. The CRCC code revisions are coming.

RPro, Thank you for the heads up. That Advisory opinion is consistent with a Cease and Desist from the CRCC to Philadelphia/Dallas/Pittsburgh. Someone should educate the CRCC the difference between a prescribed narcotic and substance abuse. Stupid is as stupid does.

The CRCC recently listed the advisory opinion issued related to the case study on this website. It is 11/07 (2). The Insurance Company CRC completely crossed the line in the TSA. Here are some excerpts: The Committee considered a request for an advisory opinion pertaining to whether it is ethical for a CRC to proceed with the placement of a client who is currently an active substance abuser.... the Committee indicated that it would be unethical for a CRC to place a client...further, they responded that it is critical for CRCs to operate within the boundaries of their competence working jointly with treatment team members to develop a mutually agreed upon treatment plan....Finally, the Committee noted that CRCs who find that the demands of an affiliate organization conflict with the Code should work toward change within the organization, specifying the nature of the conflict to supervisors or other responsible officials...

Thanks for the info. The whole disability claim process is a virus. ERISA has created a monster.

Regarding limitations one only needs to look at the Supreme Court's docket. There are ERISA cases that may help claimants in the future. Philadelphia's army of lawyers may have their egregious conduct stymied in the future. One of their own already walked away (or was let go) from her job at the end of the case study.

To Dr. M, Great observation. What troubles most people about this scam is the people in Philadelphia are not concerned about a "virus", they created it and defend it. It is that "virus" that leads ordinary people in positions of Appeal Manager, Claim Manager and Vocational Experts (CRC) to spurn ethics, federal guidelines and decency. Philadelphia condones, defends and encourages it.

Unum did not teach the industry anything. The Attorney Generals need to investigate these cases. How many people need to be destroyed before these crooks are put under the hot lights.

The Insurance Industry is in bed with the CRCC. This pathetic scenario only happens when the body charged with overseeing the profession loses sight of the "client". Great website.

This is one of the great challenges to the insurance industry's ERISA scams. Simply amazing. I assume this case has not gone the judicial route yet and you are riding the statute of limitations. I'll bet some of the boys and girls in Philadelphia are just shaking their head saying how the hell did we get here and how do we stop the virus.

All of these cases being overturned by the Courts indicates a systemic problem. The CRCC really needs to step up and mandate some rules. Flying by the seat of one's pants is not professionalism. Too many morons running around fooling themselves into believing they are "experts".

Keep digging and stay positive. Results will be apparent in due time.

Thank you for trying to correct a problem that has existed for many years. Use of the transferable skills analysis in disability claim management without a Local Labor Market Survey amounts to no analysis at all. When are we going to start policing this nonsense?

If the SSA and the IARP admit the foundation of the transferable skills analysis is flawed or disconnected why is it used? I am confused. PS. Your link to the ssa rfp was changed or removed by the ssa

Rehabilitation counselors are not experts. Insurance companies refer to CRC's as experts in claim management for their own monetary reasons.

That post yesterday is raising eyebrows. I liken it to an auto mechanic using a 1991 manual to fix a 2008 auto. To say the technology had changed during that time would be an understatement and to call the mechanic an expert of the 2008 vintage would be fraudulent.

The evidence keeps mounting. You are doing a wonderful job uncovering the truth about disability claims and how people get screwed by the insurance industry. CRC's, RN's and MD's are used by the companies to control claims. It is a sick game. I know. Someone mentioned Erin Brockovich, this will be very similar when it is exposed.

Great Update. You have just proven what everyone needs to know using the industry's own written words. The use of transferable skills analysis using the DOT and O*Net in disability claim management is a fraud. The Dictionary of Occupational titles has not been updated in 17 years and O*Net is a mish mash of incoherent information. I made a copy of the IARP response, it says it all. I think a poster sized version should be forwarded to the CRCC. They don't have a clue.

Great information. Thanks for your efforts.

Contested Case Rules apply!!

The problem with vocational counselors is they are mostly idiots posing as intelligent, educated people. As soon as you enter the door of the office and they say hello you realize you are in the presence of a poser with no identifiable specialty other than some silly school handed a bozo a degree calling the person a "specialist" or "expert". Vocational Counseling in it's present form is a BS profession that dips into society's pockets every day. Great site, I hope you keep it up for a long time for all to see. Posers beware.

This is an important week.... Keep your eyes and ears open.

The CRCC does not disclose who or what regarding letter of instruction or cease and desist adjudications for legal reasons. I agree the policy protects the CRC, organizations that employ CRC's and the CRCC. You are right that the complainant is unfortunately left in the dark. I personally believe the cease and desist secrecy is not in the public interest because it shields the offending behavior from public scrutiny. Any unprofessional or unethical activity that warrants a cease and desist order should be in the public domain. With regard to the letter of instruction I believe the secrecy is acceptable because it is used as an educational tool.

I am of the opinion the CRCC is fighting the same cause as Thetsascam (whoever you are). The balancing act is extremely difficult with insurance companies involved. I think the case study is an extreme case of unprofessionalism. I sincerely doubt the CRCC views that garbage as ethical. If they do then we are dealing with both moral and professional corruption.

Canary is spot on. Stay patient. People are very worried.

Found the site via Findlaw doing research. Thank you for your efforts. i will check back often.

Thanks for all of the recent comments and communication. Visits to the website are absolutely booming. It is astonishing. The word is spreading and the pressure is mounting. Two quotes - "Leaders are people who do the right thing: managers are people that do things right." and "fear clogs, faith liberates"- Elbert Hubbard

Apparently you are not aware of the pressure at these organizations to produce results ---denials--- at the highest levels. They call it cost containment but it really is a numbers game. Many times a determination of disability is rendered below that is blown out above. The puppeteer at the top moves the pieces so that none of the employees (admin, nurse, md) below knows what the final results of their action. ...........FIGURING OUT THE INTERNAL EMAIL SYSTEM WAS BRILLIANT. It made the organization question itself. I'm having fun watching this unfold bcause the whole scene is disgraceful. You have my email.

Talk is cheap. The CRCC and the professional organizations need to get down to business. Setting standards for the insurance referral business would be a good thing for everyone involved. Since this web site was posted the awareness level is heightened. While I have a few issues with the content the overwhelming majority is consistent with the current state of affairs. The referral process in its current form is a shady business. Very gray. Good luck with your mission. I support it.

Thanks for the information. The CRCC operates in a bubble when it comes the transferable skills analysis. They know it is abused by the insurance industry and they have done nothing.

The judicial system regards the rehabilitation counseling profession as a joke in ERISA cases. Without standards and rules or guidelines the entire vocational evaluation is nothing more than a payoff for a result. Most of the counselors playing that game are dopes that could not succeed unless they operated on the fringes of legitimacy. I applaud your efforts. The CRCC should be ashamed of its inaction on the tsa.

The Erin Brockovich of ERISA!!!!! letters upon letters, knocking on doors, questioning professionals, uncovering the greed. Good will come of this. People involved will go down.

So many claimants have been screwed over the past couple years. You are scaring some people. They do not like curveballs. Something will break, be patient.

The pressure from Insurance Companies is enormous. While I agree the CRCC should revise the Code of Ethics (as they are doing), the Insurance Companies need some tighter oversight. The blame for this outrage does not only lie on the shoulders of the CRCC. I am glad the website is also taking aim at the Insurers and others involved.

This website is a calling to all regulators!!! Come on now, the case study and the Combe case are examples of egregious conduct that is system wide. The abuse will not stop without government intervention.

Thanks for speaking the truth. TSA's have been abused for years in disability management. The rehabilitation counseling field is riddled with people who have no business being an authority on anything, much less vocational capacity evaluations.

"Anything I've ever done that ultimately was worthwhile...initially scared me to death" ......"When people go to work, they shouldn't have to leave their hearts at home.â?� - Betty Bender........."Stand up and save people from corporate and individual greed, stop being a coward" - me

"Within the last 48 hours, I received e-mails from CIGNA employees who said that this was a corporate policy - to deny, deny, deny," Geragos said, according to CBS. - This article is a must read ----- http://rawstory.com/news/2007/ Cigna_officers_defend_decision_to_ let_1225.html

WTF.....If the stuff in this case is legal after the UNUM PROVIDENT debacle there is a continuing problem in the disability insurance business. Dishman v Unum take two. My head is spinning trying to determine if it is money, blind loyalty, arrogance or stupidity or combination of all of them involved. My guess is this type of abuse will end up landing people and companies on the hot seat. Who is going to be the whistleblower? Someone always breaks first.

"The man who has garnered millions at the expense of his conscience is a failure"- BC Forbes...........doctors, lawyers, counselors etc. are not immune. Great site, I think some folks are worried.

Looks like an attorney working for the insurance company has moved on in January. One can only hope these folks are beginning to look in the eyes of corporate evil and decide they don't want to be a part of it anymore. Too little, too late. Have fun with the photoblog.

Incredible compilation of data and information. A must read for every regulator and judge. You should add John Langbein's work to the education section. The insurance industry has been utilizing every strategic legal manuever possible to deny claims. All working people covered by ERISA are at a disadvantage.

The CRCC updated the news section of the web site to include their most recent newsletter - winter 2007. Topic number one is "REVISIONS TO THE CODE OF ETHICS".

There was a doctor named McSharry who blew the roof off the claim denials......."Defendant expected the medical advisor to render opinions on conditions outside his or her specialty rather than to refer the file to a specialist in the field. It also required the non-specialist to support his training in the particular specialty even where the support required falsification. "Although an appeal of a denial is supposed to be reviewed independently and de novo, it is defendant's practice to rely on the original evaluation of the case." The plaintiff said in his first five months at UnumProvident he "tried to work out his ethical dilemma with defendant's practices and his role in them by walking a careful line, trying to follow defendant's express rules while still rendering truthful reports." http://stopunum.com/ex-unum-dr-mcs harry-gives-consolidated-deposition/

Robert Anfield (Bob) worked at UNUM and so did Cigna's SVP of Group, Mark Marsters. I'm surprised Bob landed at Cigna. He has moved around over the past few years after the Unum settlement. The case on this website is extremely bizarre. I do not get why a ten year old case ended in this fashion. Was Anfield involved?

The upcoming NCRE spring conference agenda includes a session entitled "Certification of Vocational Forensic Professionals - A Call to Action". Serious rehabilitation professionals are getting tired of the Insurance Industry's games. It is time to raise the bar to protect the client.

OMIGOD.... It is amazing that physicians that never see patients and never perform surgery render decisions in disability cases. They are not real doctors. Real doctors do not need to cower behind desks to get a "lucrative" payday. This web site is really uncovering some unseemly behavior.

I can not believe Cigna authorized the participation of one of their employees in that conference. I wonder why disability consulting is so LUCRATIVE!!!!! It is just like the CRC referral game. Everybody is making money in the claim denial machine.

I hear this site has sent some rumblings through the profession. It is about time.

Thanks for the information. I have had a nightmare with my disability claim. This site was a valuable resource.

Regarding other designations. The CDMS, CVE and CCM designations all originate out of the same place as the CRC designation - Schaumberg IL - and they all require unbiased, objective, ethical reports. Many people hold multiple designations however the CRC designation appears to be the most common hire for insurance companies in disability claims performing TSA's. Thetsascam belives change (ie. instituting TSA standards) must start at the CRC level.

That is an amazing compilation of cases in the education section. Thanks to the researcher.

correction: should read "done by" (not "done both"). Apologies.

Are all TSAs required to be done by a CRC? What about TSAs done both employees of insurance companies with other designations?

Thanks again for all of the thoughtful comments. By no means does this site consider all CRC's to be pawns, poorly educated, driven by greed etc. Quite the contrary, this site believes the Insurance Industry has found a small number of CRC's that press the ethical boundaries to save the insurance industry 100's of millions of dollars in claims. This site wants the CRCC to take an active role in protecting clients while also leveling the playing field so that a small number of CRC's do not undermine the profession as a whole. The majority of CRC's should want the same. Enjoy the rest of the holidays and thanks for the overwhelming support. The number page views is steadily rising.

I am a CRC and while I am not aware of the particular cases you mentioned, I do not work with insurance companies because their main goal is to return the person to work, despite their disabilities. To be fair and balanced, many CRC's do a great job and do care about the client. TSA while not scientific, provide an overview of what skills may transfer to other occupations. Public State Agencies and private agencies use these as a gage to look into other occupations for clients. As a CRC, I am a proponent of helping clients return to work and disabled clients want to return to work as well, but it should be appropriate work and carried out with the client's interest in mind, not the insurance company's interest.

If the CRCC did not take firm measures against the counselors in that case the CRC designation is in jeopardy of losing its credibility. If this site gains momentum and awareness I see trouble ahead for all parties involved. I do not see a mention of the surveillance in the case docs, why? Also why videotape the pregnant wife and child?

The case on the homepage is not the work of professionals. Collectively everyone involved let the client down. I think it is time to stop handing out CRC designations to people who do not respect the profession.

Another transferable skills analysis tossed by a Judge: http://ddbchicago.com/archives/casenote%20of%20month.htm

This case is an outrage. Whoever was involved should have their certification revoked. I hope the CRCC sent copies of the ceast and desist orders to all fifty states.

Moral excellence comes about as a result of habit. We become just by doing just acts, temperate by doing temperate acts, brave by doing brave acts.................KEEP PLUGGING AWAY

You are being heard. The IARP has put together an instructional class entitled: ETHICAL CONSIDERATIONS IN DISABILITY MANAGEMENT - With the employer focus on cost containment, how do we ensure that our program designs and resolution of an individualâ??s escalated issues meet the fundamental principles of ethical behavior? Ensuring compliance with governmental regulations is a good start, but is it enough? Do the employers you work with suffer from periodic bouts of â??managerial mischiefâ??? Register for this thought provoking session to learn how to coach employers through a framework for ethical decision making. Case studies will be provided. The CRCC and CDMS Codes of Ethics will be used.

The CRCC took action and will in the future if a complaint is filed. Anyone in the field that has reviewed this case knows it is a nightmare. Your message has to find those with the power to deal with the insurance companies. The CRCC is obligated to alert State authorities of their actions but it up to the State to act. Please take a deep breadth. Trust some people.

Thanks again for the feedback and suggestions. All options are on the table. This process really has only reached DEFCON 1 hoping certain parties would see the light but that doesn't appear to be the case. As we dig, the names of parties associated with previous claim bebacles at other companies are reappearing in these recent cases. This TSA SCAM appears to be systemic and involves CRC's, claims adjusters and medical directors. Please pass the site link on to others.

File a complaint against the CRC and the company that generated the Cease and Desist orders, Letters of Instruction etc. ERISA does not provide immunity to Counselors, Physicians and other professionals. Get the records through the court.

Get the State Attorney Generals involved. If cease and desist letters don't open their eyes maybe a few subpoenas will. Don't give up, there are people watching.

Can you please file any additional complaints that you have with the CRCC. I have feeling the CRCC is going to want another shot at this menace. They need a complaint and the documents to act.

Can you provide a list of email addresses for regulators and agencies so that a mass email campaign can get the word out? I get the impression the Insurers are using CRC's as loaded guns to execute claimants and the body overseeing these experts has no control. I see a crisis that needs to be addressed by regulators.

This site is opening one very big can of worms.........

1. The records of the Ethics Committee regarding complaints are confidential except as provided herein. a. All information concerning complaints against Certificants shall be confidential except that the Committee may disclose such information when compelled by a validly issued subpoena or when otherwise required by law or valid court order.

Thank you so much for all of the helpful and informative comments. This web site will strive to be fair while seeking change. Regarding recent CRCC actions please see "Recent Updates" on the home page. Does anyone believe the insurance industry learned a lesson from the UP claim settlement? Same nonsense, different victim. Visitors and contributions (even if anonymous) to this site are on the rise for the following reasons - 1. Interest in "change" for the public good 2. helping the little guy/gal 3. Fighting for the integrity of one's profession 4. search engines 5. a distrust of the insurance industry. Thanks again. This web site and awareness campaign is back in full swing.

After reading this material it is very easy to see how the insurance companies can manipulate the DOL ERISA claim procedure 29 CFR 2560.503-1 to save themselves mammoth sums of money. Using so called experts to justify questionable actions the claim denial/appeal process is used to wean out claimants w/o the resources to maintain the battle. Looking forward to the further updates.

The site should reevaluate it's position on the home page regarding CRCC Complaints in ERISA. The CRCC ethics committee has numerous tools to help folks wronged by certificants. For example, the case posted on the homepage probably generated Cease and Desist orders, advisory opinions, letters of instruction and suspensions. The CRCC will not allow certificants and their employers to devalue the Code of Ethics or the profession. Good luck.

The CRCC does have a tool at their disposal when an ethical violation is difficult to find. It is called a "Letter of Instruction". The letter of instruction is a type of disposition status adopted in 1997. It does not involve a judgment that there was an ethical violation. Rather, it represents instructive advice to the certificant to clarify and improve the best standard of ethical practice.

Thanks for the information. I learned a lot about the process and my rights.

Where are the regulators? This type of "expert" rope-a-dope with the claimant is ridiculous. It is easy to see the millions ($) upon millions ($) the Insurers can save themselves deploying these tactics. Why are counselors letting themselves be played like this? They know damn well one-sided input creates one-sided output. All rehabilitation counseling education programs teach that.

After looking at those documents I wanted to puke. The Insurer and the VE's collectively distorted every possible 50/50 to create a conclusion that could have just as easily been interpreted the other way. That is not a coincidence. Disappointing is all I can say.