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By Mail: Office of Regulations and Interpretations,

Employee Benefits Security Administration

Room M-5655

U.S. Dept. of Labor

200 Constitution Avenue NW

Washington D.C. 20210

Re: Re-Examination of Claims Procedure Regulations for Plans Providing 

Disability Benefits

RIN No.: 1210-AB39

Regulation: 29 C.F.R. §2560.503

Dear Deputy Assistant Secretary Hauser:

I am writing to discourage the Department from modifying or further delaying the final 

disability claims regulations (Final Regulation on Claims Procedure for Plans Providing 

Disability Benefits, 81 Fed. Reg. 92316 (Dec. 19, 2016)) that are now scheduled to go 

into effect on April 1, 2018. 

For eight years I represented claimants in ERISA benefit matters both in the internal 

appeal process and in litigation. The vast majority of my clients were seeking to reverse 

denials of disability claims. For the last five years I have worked as a consultant to other 

ERISA benefits attorney for whom I provide advice, perform research and analyze legal 

decisions. In that capacity I read hundreds of ERISA decisions and court filings each 

year. Most of these address full and fair review in some way.

Thank you for the opportunity to comment on the Department’s re-examination of the 

costs of the final rules governing disability claims, and thank you for clarifying that the 

Department will accept more comments as needed in response to the industry’s 

submissions. However, it is not clear to me that this process is necessary, as it appears to 

be the industry’s attempt to re-litigate questions that the Department has already 

addressed in the final rules. As I mentioned in previous comments, I am concerned with 

the lack of transparency in the process and question the Department’s decision to 

reexamine the rules because of private meetings between industry players and the 

Department, where one-sided perspectives were allowed to dominate. 

Nevertheless, I will address the objections that have been raised that I feel are most in 

need of a response.

Costs Will Not Increase

The industry’s logic - that the rules will increase administration costs, which in turn will 

cause premium increases, which in turn will reduce employees’ access to disability plans

- has no basis. I would not allow the industry to prescribe what is good for ERISA 
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disability plan participants. The Department has already acknowledged that the disability 

claims industry has been needlessly adversarial toward ERISA disability plan 

participants, and it has received many comments confirming that this is so. The 

industry's argument that the final rules are bad for participants – despite all evidence to 

the contrary - cannot be taken seriously. The industry is not trustworthy advocate for 

participants. 

Indeed, there is data already available that shows the parade of horribles predicted by the 

industry will not take place. The Bureau of Labor Statistics’ February 2015 publication, 

Beyond the Numbers, Disability Insurance Plans; Trends in Employee Access and 

Employer Costs, addresses these concerns. https://www.bls.gov/opub/btn/volume4/disability-insurance-plans.htm. There was an increase in participation between the years 

of 1999 and 2014, a period of time that obviously covers the promulgation of the 2000 

claims regulations. This increase occurred despite that employment in the service 

industry has increased, an industry in which employees are less likely to have access to 

employer-based disability coverage. This increase also occurred despite a number of 

court decisions that continued to heighten the plans’ obligations. I would therefore be 

suspicious of any data supplied by the industry now that suggests employers would 

abandon disability coverage due to the final rules. This BLS document also demonstrates 

that the cost of disability insurance is low, a possible explanation for why modest 

increases don’t seem to lead to less participation.

The Department has also asked for data about whether disability premiums increased in 

response to the adoption of state statutory bans on discretionary language clauses in 

disability policies. Notably, during the time period covered by the BLS publication,

many states enacted discretionary clause bans. A list of these states includes, but is not 

limited to, Arkansas Admin. Code 054.00.101-4 (2013); Cal. Ins. Code §10110.6 (2012); 

Colo. Rev. Stat. §16-3-1116 (2008); 50 Ill. Admin. Codes 2001.3 (2005); Md. Code ann. 

Ins. §12-211; Mich. Admin. Codes. R. 500.2201-2202 (2007); R.I. Gen. Law §§ 27-18-

79; Tex. Admin. Code §3.1202-1203; Tex. Ins. Code §1701.062, §1701.002 (2011); 

WAC §284-96-012 (2009). These state regulations have not affected access or

participation. 

Also, during the period covered by the BLS publication, two major insurers with 

significant market share, UNUM and CIGNA, were examined by the states for poor 

claims handling practices. As a result they became subject to fines and Regulatory 

Settlement Agreements that raised the bar for their disability claims administration. 

http://www.maine.gov/pfr/insurance/publications_reports/exam_rpts/2004/unum_multista

te/unum_multistate.html. (Although I am sure the Department has access to it, A Copy 

of the Cigna Regulatory Settlement Agreement is uploaded with these comments.) 

Nonetheless, during this period access and participation increased. 

An additional reason that employers are not likely to stop providing disability benefits is 

that these benefits play a role in recruitment and retention. MetLife, one of the industry’s 
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large disability insurers, urges employers to consider how benefits, including disability 

benefits, increase loyalty and productivity and reduce the apparently rampant worries of 

financial insecurity. https://benefittrends.metlife.com/us-perspectives/work-redefined-anew-age-of-benefits/; 

https://benefittrends.metlife.com/media/1168/2016_ebts_opportunityknocks_insights.pdf.

To the extent that the industry also argues that increased costs will lead to employers 

requiring employees to pay their own disability premiums, this is not necessarily an 

unwelcome thing. Where the disability claimant pays his own premiums with after-tax 

dollars, his disability benefits are tax-free. This is an enormous benefit to many disability 

claimants. 

The Department should not change the final rules in response to the industry’s cost 

argument. Nor should the industry’s cost argument cause the Department to extend the 

effective date further. 

The Benefits Outweigh the Costs

Regulations are not improper just because they affect the market. Mkt. Synergy Grp. v. 

United States Dep't of Labor, 2016 U.S. Dist. LEXIS 163663, 2016 WL 6948061 (D. 

Kan. 11/28/2016). 

But assuming that the final regulations have some impact on cost, the costs will not 

outweigh the benefits. The Department has already articulated its purposes – to make 

sure claims are fairly adjudicated and to prevent unnecessary financial and emotional

hardship. The Department should ignore the industry's invitation to abandon these 

purposes. Moreover, these benefits cannot be outweighed by costs where ERISA 

claimants are at such a procedural disadvantage. 

ERISA disability claimants who are denied their benefits face a process that is far below 

the standard for regular civil disputes. These procedural hurdles include: (1) there are no 

jury trials; (2) there is a closed record from the claims process that can rarely be 

supplemented in litigation; (3) courts often apply an unfavorable standard of review, and 

(4) there are no remedies to discourage unfair and self-serving behavior on the part of 

plans. This will never be a level playing field much less one that favors plan participants. 

United States v. Aegerion Pharmaceuticals, Inc., 2017 WL 5586728, at *7 (D.Mass.

11/20, 2017)("The insurance industry found it could largely immunize itself from suit due 

to the Employee Retirement Income Security Act (“ERISA”).) Even with the final rules 

in place, plan participants will not have achieved the “higher-than-marketplace 

standards” that the Supreme Court insists are required in processing ERISA claims. 

MetLife v. Glenn, 554 U.S. 105, 115 (2008). Any consideration the Department makes 

about the benefits of the final rules relative to costs should take these “higher-thanmarketplace” standards into account. It cannot be the case that any minor increase in 
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costs justifies denying ERISA claimants the limited protections that the final rules 

provide. 

Furthermore, from the perspective of plan participants, an inexpensive but illusory 

disability plan is worse than no plan at all. It is important to note that when a disability 

claimant is unfairly denied benefits that she thought were promised through an 

employer's plan, it is too late for him to purchase private individual insurance to cover the

risk of becoming destitute. It is only at the point of becoming disabled that claimants 

discover the procedural hurdles that are unique to ERISA claims. Attorneys often have to 

turn down representation of ERISA disability cases that are otherwise meritorious 

because the record is closed or the claimant had not realized that a contractual limitations 

period had passed. To the extent that increased protections bring disability claims 

administration in line with the reasonable expectations of the employee-participants, the 

costs are outweighed by the benefits. This is what is meant by higher-than-marketplace 

standards. 

In sum, if there are costs associated with the final regulations, these costs could and 

should be tolerated in the name of supplying a modicum of protection for plan 

participants.

Requiring the Plan to Discuss the Basis for Disagreement with Social Security 

Decisions or Other Contrary Opinions is Not Costly.

This rule merely requires disability plans to observe a fundamental due process principle 

that is imbedded in ERISA—namely the principle that a claimant is entitled to a wellarticulated explanation for the adverse benefits decision so that the participant may fairly 

dispute it. The 2000 regulations require no less. 

As the Department has already noted, it is doubtful that there are costs associated with the 

requirement of discussing the reasons for disagreeing with a favorable Social Security 

decision. ERISA disability benefits have always been deeply intertwined with the Social 

Security system and mostly are simply supplemental to Social Security benefits. For 

some employees a Social Security award will wipe out their entire ERISA benefit or 

reduce it to a mere $100 per month. Most disability plans require claimants to apply for 

the SSA benefit, and the plans usually provide representation for claimants. This is done 

so that the plan may take advantage of the plan term that the SSDI benefit will offset the 

LTD benefit. In order to decide which claimants qualify for this representation, claims 

handlers need to know the standard that the SSA uses. Comment #114, p.8 (ACLI). As 

such, their claims manuals tend to include pages of instructions related to Social Security 

disability and its standards. Both the Unum and Cigna Regulatory Settlement 

Agreements required the insurers to give greater weight to the Social Security awards. 

The insurers are no strangers to the SSA process or its standards. 
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To the extent that the industry argues that increasing the cost of disability insurance will 

burden the government, and more specifically the SSA, the Bureau of Labor Statistics 

publication speaks to this: 

It is important to note that expanding access to employer-provided 

disability insurance would not necessarily relieve the burden on 

SSDI. The ability to access disability insurance does not affect a worker’s 

eligibility for SSDI. People can receive SSDI benefits and long-term 

disability payments, but the private disability insurance payment is usually 

reduced by the amount of the SSDI payment. 

https://www.bls.gov/opub/btn/volume-4/disability-insurance-plans.htm.

Additionally, courts in many jurisdictions require an explanation of a favorable Social 

Security award. Montour v. Hartford Life & Acc.Ins Co., 588 F.3d 623, 635-637 (9th Cir. 

2009); Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 679 (9th Cir. 2011); 

Bennett v. Kemper Nat. Services Inc., 514 F.3d 547, 553-554 (6th Cir. 2008); Brown v. 

Hartford Life Ins. Co., 301 F. App'x 777, 776 (10th Cir. 2008). As a matter of Supreme 

Court precedent, it is arbitrary and capricious for the claims administrator to advocate for 

Social Security benefits, reap the benefit of the Social Security award by means of an 

offset, and then ignore the SSA’s determination. Metropolitan Life v. Glenn, 554 U.S. 

105 (2008). As the industry comments often acknowledged, requiring an explanation of 

the reasons for disagreeing with the Social Security decision and other contrary evidence 

tracks the existing standard. Logically, it should not increase costs to simply codify this 

standard. 

A rule clarifying that an explanation of the basis for disagreeing with a Social Security 

decision is a requirement will increase uniformity and predictability in the process, which 

is generally associated with costs savings and not cost increases. 

The Deemed Exhausted Rule is Not Costly

The industry’s concern about this rule seems to be that plaintiffs and their attorneys will 

race into court, increasing the volume of ERISA litigation and hence the overall costs of 

administering disability claims. This is incorrect. Plaintiff’s attorneys are ever mindful 

of building a record on which the court will make its decision and therefore would rather 

engage in the appeal process and exhaust internal remedies. This serves the dual purpose 

of possibly resolving the dispute and creating a record for the court to review in case the 

dispute cannot be resolved internally. Under the final rule, the plaintiff will mostly 

obtain a remand with instructions for the plan to do its job. Because plaintiff’s attorneys 

usually work on a contingent fee basis, it does not make sense to undertake litigation that 

is not absolutely necessary and that will not result in resolving the case on the merits. 
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Further, a court will only award attorney fees for litigation where the plaintiff has 

achieved some degree of success on the merits. Hardt v. Reliance Standard Life Ins. Co., 

560 U.S. 242, 255 (2010). In other words, the industry comments are seriously out of 

step with litigation in the real world and how the incentives are aligned to discourage 

litigation. While this rule may appear to create additional trips to court, it will not do so 

except in the most extreme cases. I take it that addressing these extreme cases is the 

purpose of the final deemed denied rule. 

Additionally, as with most of the other final rules, this rule is mostly a codification of 

existing judge-made law. Claimants are already able to get into court when the claims 

process has failed them in a meaningful way. See e.g. Brown v. J.B. Hunt Transp. Servs., 

586 F.3d 1079, 1085-86 (8th Cir. 2009) (failure to respond to request for documents 

excused claims from exhaustion requirement because there was no full and fair review). 

It is not likely that additional costs will result from this regulation. Hall v. National 

Gypsum Co., 105 F.3d 225, 231-32 (5th Cir. 1997); LaAsmar v. Phelps Dodge Corp. Life, 

605 F.3d 789 (10th Cir. 2010); Nichols v. Prudential Ins. Co. of Am., 406 F.3d 98 (2d Cir. 

2005); Jebian v. Hewlett-Packard Co. Employee. Benefits Org. Income Prot. Plan, 349 

F.3d 1098 (9th Cir. 2003); Dunnigan v. Metropolitan Life Ins. Co., 277 F.3d 223, 231 n.5 

(2d Cir. 2002). 

Providing the Right to Review and Respond to New Evidence or Rationale From the 

Plan During the Appeal Review is Not Costly.

This rule is fundamental to full and fair review. The Department has already 

acknowledged the importance of this rule and that it is already the standard in some 

jurisdictions. The industry complains that providing the claimant with new evidence or 

rationales before making a final decision is costly. The industry’s claim to cost impact is 

suspect for several reasons. 

First, several disability plans or insurers already provide for the right to review and 

respond. They do so on a voluntary basis, as their comments to the proposed rules admit. 

Second, courts require plans or insurers to do this in many cases. Last, whether they 

provide this information to the claimant during the ERISA appeal process, they will have 

to provide it eventually in one form or another. New reasons or evidence will need to be 

included in the claim file and likely again in 26(a)(1) disclosures. Thus, the industry's 

portrayal of the chaos that might ensue if they were required to locate and supply these 

documents is not credible. If the issue is the cost of mailing, such a concern should not 

be permitted to interfere with such basic a due process right. 

It is important to note what this rule does. It permits a claimant to respond to a disability 

claims administrator’s assertions in a way that will make the response a part of the record 

if the claimant has to go to court to vindicate her rights. This is because most ERISA 

cases are decided on a closed record. Without this rule, the claims administrator’s new 
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evidence or rationale will be included in the record that the court reviews, but the 

claimant’s rebuttal will not. Perhaps what the industry is really chafing about is the loss 

of its ability to strategically withhold information that would help the claimant achieve 

reversal or win his case in court. 

If the industry’s concern is that the claims handlers need to do more in the same amount 

of time, this could be addressed by modifying the rule instead of eliminating the rule 

altogether. Commenters from both sides have suggested this approach. 

I strongly disagree with industry comments to the effect that a second appeal, which is 

offered with some plans, serves the same purpose as the right to respond to new evidence 

or rationales before a final decision. This is absurd, as a second appeal permits the claims 

administrators the same sandbagging opportunity as the first appeal. Second appeals are 

not necessarily a boon to plan participants. The disability claims regulations acknowledge

as much my limiting the number of appeals a plan can require to two. Additionally, 

second appeals are not universal and are not required. The second appeals that the 

industry touts are a matter of plan design and can be changed at any time by plan 

sponsors. It may be that second appeals will become obsolete where the claimant has a 

true right to respond. 

Other Provisions

The Impartiality Rule

Few industry commenters complained about the proposed rule requiring that consulting 

experts be impartial. Comment #76 (UNUM), Comment #92 (NFL), Comment #129 

(AHIP). These muted objections are understandable, since it is hard to argue that 

disability claims administrators should be free to hire biased experts. The majority of 

those who object to this rule admitted that the proposed rule reflects the existing law. 

Comment #76, (UNUM), Comment #92 (NFL). The industry complaints seem to be 

based on the fear of increased litigation, particularly in the form of discovery. First, 

federal judges are well versed at limiting discovery in ERISA cases in proportion to the 

needs of the case. See e.g. Paquin v. Prudential Ins. Co. of Am. 2017 WL 3189550 (D. 

Colo. 7/10/2017); Heartsill v. Ascension Alliance, 2017 WL 2955008 (E.D. Mo. 

7/11/2017; Ashmore v. NFL Player Disability and Neurocognitive Benefit Plan, 2017 WL 

4342197 (S.D. Fla. 9/27/2017); Baty v. Metropolitan Life Ins. Co., 2017 WL 4516825 (D. 

Kan. 10/10/2017); Harding v. Hartford Life and Accident Ins. Co., 2017 WL 1316264 

(N.D. Ill. 4/10/2017); Hancock v. Aetna Life Ins. Co., 321 F.R.D. 383 (W.D. Wash. 

2017); Kroll v. Kaiser Foundation Health Plan Long Term Disability Plan, 2009 WL 

3415678 (N.D. Cal. 10/22/2009). 

Next, if the impartiality rule is already the law, it is not clear how more discovery would 

result from codifying it. Additionally, the credibility of experts who are opining on 
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whether a claimant qualifies for benefits should be subject to some sort of scrutiny. If a

claimant needs to conduct discovery into whether a physician hired by the administrator 

is well known to support denials, the cost of conducting this discovery cannot possibly 

outweigh the benefits. ERISA claimants are entitled to a process that does not have a 

predetermined outcome based on which reviewing physician is hired by the plan. 

The Rule Requiring Disclosure of any Internal Limitations Period

Few industry commenters focused on the final rule requiring claims administrators to 

provide the claimant with the date when any internal time limit for filing suit will expire. 

I am assuming, therefore, that these objectors are not claiming that this rule has a cost 

impact. The claims administrators are in a position to satisfy this rule, since the 

expiration date of an internal limitations period is essentially a plan term that should be 

accessible to the plan administrator and not be hidden from unsuspecting plan 

participants. As with most of the final rules, information respecting the period of 

limitations is required to be disclosed in several jurisdictions, so it is unlikely to incur 

additional costs to create uniformity. Santana-Diaz v. Metro. Life Ins. Co., 816 F.3d 172, 

179 (1st Cir. 2016); Moyer v. Metro. Life Ins. Co., 762 F. 3 503, 505 (6th Cir. 2014); 

Mirza v. Ins. Adm'r of America, Inc., 800 F. 3d 129, 134 (3d Cir. 2015). 

The Rule Requiring Disclosure of Internal Guidelines

Few commenters objected to the proposed rule requiring claims administrator to disclose 

internal guidelines or certify that none exist. Comment #50 (DRI), Comments #76 

(UNUM). These commenters complained that internal guidelines tend to be procedural 

rather than substantive, implying that the guidelines are irrelevant. As this lengthy 

rulemaking process has shown, procedure affects substantive outcomes. So even if 

internal guidelines are procedural, that is no reason to withhold those guidelines from 

claimants. The disclosure of claims manuals and internal guidelines, which often contain 

additional plan terms that are hidden from the ERISA participants, will ultimately cut 

down on litigation, since discovery of these documents is often disputed. See Glista v. 

Unum Life Ins. Co. Of Am., 378 F.3d 113, 123-125 (1st Cir. 2004); Mullins v. AT&T 

Corp., 290 Fed. Appx. 642, 646 (4th Cir. 2008). 

Yours Truly,

Sally Mermelstein, Attorney at Law

Minneapolis, Minnesota
IN THE MATTER OF 

LIFE INSURANCE COMPANY OF NORTH AMERICA, CONNECTICUT 

GENERAL LIFE INSURANCE COMPANY, AND CIGNA HEALTH AND LIFE 

INSURANCE COMPANY (FORMERLY KNOW AS ALTA HEALTH AND LIFE 

INSURANCE COMPANY) 

Philadelphia, Pennsylvania 

NAIC # 65498 

Bloomfield, Connecticut 

NAIC # 67369, 62308 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATION 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

This Regulatory Settlement Agreement ("Agreement") is entered into as of this 13th day 

of May, 2013 (the "Effective Date"), by and among the Life Insurance Company ofNorth 

America ("LINA"), Connecticut General Life Insurance Company, and Cigna Health and Life 

Insurance Company (formerly known as Alta Health and Life Insurance Company) (the 

"Company" or "Companies"), the California Department of Insurance, the Connecticut 

Insurance Department, the Maine Bureau of Insurance, the Massachusetts Division of Insurance, 

the Pennsylvania Insurance Department (the "Monitoring States") and the insurance regulators 

who have executed the form of "Participating State Adoption" set forth at Exhibit A (along with 

the Monitoring States, the "Participating States"). 

A. Recitals 

1. At all relevant times the Companies have been licensed insurance companies 

domiciled in the Commonwealth of Pennsylvania and State of Connecticut and authorized to 

write life and health insurance in the Participating States. The Companies are wholly owned 

subsidiaries ofCG Corporation, a Connecticut holding company. CG Corporation is in tum a 

wholly owned subsidiary of CIGNA Holdings, Inc., a Delaware holding company. The ultimate 

parent of the Companies is CIGNA, Corp., a Delaware holding company (collectively with its 

member insurers, the "CIGNA Companies"). The Companies are the members of the CIGNA 

Companies writing long term disability income insurance ("LTD") policies in the Participating 

States. The Companies offer only group LTD policies in the Participating States. They do not 

offer individual LTD policies in the Participating States. 

2. On September 15, 2009, the Maine Superintendent oflnsurance and the 

Massachusetts Commissioner of Insurance initiated targeted market conduct examinations (the 

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"New England Examinations") of the CIGNA Companies writing disability income insurance 

regarding their claim handling practices in Maine and Massachusetts. Among other things, the 

Examinations investigated whether the Companies' claim handling practices conformed with the 

standards reflected in the National Association of Insurance Commissioners ("NAIC") Unfair 

Methods of Competition and Unfair and Deceptive Acts and Practices in the Business of 

Insurance Model Act (1972), NAJC Claims Settlement Practices Model Act (1990) (together, the 

"Model Act"), and the Maine and Massachusetts unfair insurance trade practices acts, pursuant 

to the procedures established by the NAJC Market Regulation Handbook (the "Handbook"). The 

examiners also used the terms of the Multistate Regulatory Settlement Agreement entered into 

by forty-nine of the United States insurance regulatory jurisdictions and the United States 

Department of Labor with the principal insurers ofthe Unum Group in 2005 ("Unum RSA") as a 

benchmark for their review. The two examinations were conducted simultaneously, on a 

coordinated basis by the same examiners pursuant to the Model Act, relevant Maine and 

Massachusetts statutes and regulations, and the Unum RSA. 

3. Examination reports regarding the New England Examinations are being released 

concurrently with this Agreement. Each of those examination reports contemplates the 

execution of this Agreement. 

4. As a result of the New England Examinations, the Maine Superintendent oflnsurance 

and the Massachusetts Commissioner of Insurance engaged in discussions with the Companies 

with respect to regulatory concerns raised by the examiners and a plan of corrective action by the 

Companies to address those concerns. 

5. In November 2011 examiners briefed the Connecticut Insurance Commissioner and 

the Pennsylvania Insurance Commissioner regarding the regulatory concerns raised by the New 

England Examinations. 

6. On August 18, 2009 the California Department of Insurance and LIN A entered into a 

Stipulation and Waiver Agreement addressing the findings of a market conduct examination of 

UNA's LTD claims handling practices as of June 20, 2006 (the "2006 California Examination"). 

On October 1, 2010 the California Commissioner of Insurance initiated a follow-up examination 

ofLINA (the "2010 California Re-Examination") to discover, in general, ifthe Companies' 

group LTD claims handling practices conform to the contractual obligations of its policy forms, 

the California Insurance Code, the California Code of Regulations, and case law. An 

examination report regarding the 201 0 California Re-Examination was adopted by the California 

Commissioner oflnsurance on June 4, 2012. (Collectively, the New England Examination, the 

2006 California Examination, and the 201 0 California Re-Examination are referred to as the 

"Examinations"). 

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7. In light of the regulatory concerns raised by the Examinations, the Monitoring States 

entered into discussions with the Companies regarding resolution of the regulatory concerns 

raised and the establishment of a uniform plan of corrective action. 

8. After discussion, the Companies agreed to the plan of corrective action set forth in 

this Agreement, the establishment of a remediation program for the redetermination of certain 

LTD claims, and the payment of certain fines. The terms and conditions of this Agreement will 

apply in all of the Participating States. 

9. The plan of corrective action addresses a number of regulatory concerns arising from 

the Examinations. It seeks to accomplish the following: 

a. Enhance claim procedures to improve the claim handling process and benefit current 

and future insureds as described in this Agreement, including Exhibits B, C, and D; 

b. Monitor the Companies' implementation of these claim handling procedures by 

means of (i) regular meetings between a management team designated by the 

Companies and Monitoring States (as defined in paragraph B.5, below) and (ii) a 

follow-up examination; and, 

c. Establish a Remediation Program in which, as described more fully in Exhibit F, the 

Companies' enhanced claim procedures will be applied to certain previously denied 

or adversely terminated claims. 

10. This Agreement sets forth (i) the plan of corrective action, (ii) provisions concerning 

the enforcement of the Companies' compliance with the plan of corrective action, (iii) the 

Remediation Program, and (iv) other miscellaneous provisions of this Agreement. 

11. Location of Definitions. (paragraph at page number) 

"2006 California Examination" ........ A.6 at 2 "LINA" .................................... Preamble at I 

"2010 California Re-Examination" ... A.6 at 2 "LTD" ............................................... A.1 at 1 

"Agreement" ............................ Preamble at 1 "Medical Director" ......................... Ex. D at i 

"CIGNA Companies" ....................... A.1 at 1 "Model Act" ...................................... A.2 at 2 

"Company" or "Companies" .... Preamble at 1 "Monitoring States" ................. Preamble at 1 

"Effective Date" ....................... Preamble at 1 "NAIC" ............................................. A.2 at 2 

"Examinations" ................................. A.6 at 2 "New England Examinations" .......... A.2 at 2 

"FCE" ............................................. B.1.c at 4 "Participating States" ............... Preamble at I 

"Handbook" ...................................... A.2 at 2 "Plan" ................................................... B at 4 

"IME" ............................................. B.1.c at 4 "Professional" ................................. B.I.f at 5 

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"Remediation Period" ..................... Ex. F at i "SSDI" ........................................... B.l.a at 4 

"Remediation Program" .................... B.4 at 6 "Unum RSA" .................................... A.2 at 2 

"SSA" ............................................. Ex. Bat i 

The definitions contained in this Agreement shall apply equally to the exhibits to this 

Agreement. Where a term is expressly defined in an exhibit, the definition in that exhibit shall 

control. 

B. Plan of Corrective Action (the "Plan") 

The procedures described below reflect the Companies' and the Participating States' view of best 

practices for adjusting group LTD claims and do not necessarily reflect examiner findings that 

the Companies have actually engaged in any of the conduct which those procedures are designed 

to avoid. 

1. Enhanced Claim Procedures 

The Companies are committed to ensuring full and fair evaluation of insureds' eligibility for 

and entitlement to disability benefits. A cornerstone of those evaluations is the Companies' 

commitment to gather and consider information that is relevant to the claim determination, as 

set forth below. 

a. Procedures regarding the weight to be given to awards of Social Security Disability 

Income ("SSDI") benefits. Guidelines, in the form attached as Exhibit B, regarding 

the weight to be given to the awards of SSDI benefits have been adopted by the 

Companies, circulated to all personnel involved in the determination of LTD claims, 

and will be included in the future training of such personnel. 

b. Enhanced procedures regarding the gathering of medical information and the 

documentation of conclusions. Enhanced procedures, in the form attached as 

Exhibit C, regarding the gathering of medical information, analysis of such 

information, and the documentation of claim personnel's conclusions have been 

adopted by the Companies, circulated to all personnel involved in the determination 

of LTD claims, and will be included in the future training of such personnel. 

c. Guidelines for Use of External Medical Resources. Guidelines, in the form attached 

as Exhibit D, clarifying the use of external medical resources-- including, as 

appropriate, an Independent Medical Evaluation ("IME") or a Functional Capacity 

Evaluation ("FCE") -- in making a disability analysis have been adopted by the 

Companies, circulated to all personnel involved in the determination of LTD claims, 

and will be included in the future training of such personnel. 

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d. Ongoing objectives. The Companies' claim procedures shall include the following 

ongoing objectives: 

1. Focus on policies and procedures relating to medical and related evidence, as 

specifically described in this Agreement, including Exhibits B, C, and D. 

u. Clear and express notice to claimants of the information to be provided by the 

claimants and the information to be collected by the Companies. If a file is 

determined to lack sufficient information, claim handling personnel will take 

reasonable steps to work with the claimant to identify and obtain such 

information in accordance with appropriate procedures established for such 

purposes. 

The Companies shall ensure that their policies and procedures are consistent with the 

foregoing objectives. These objectives shall constitute criteria by which the 

Companies' claim handling performance shall be evaluated during the course of 

ongoing monitoring (discussed more fully in paragraphs B.5 and B. 7 below) and 

during the follow-up re-examination (discussed more fully in paragraph C.2 below). 

e. Selection of Evaluation Personnel. The Companies affirm and will continue their 

existing practice of selecting individuals to conduct IMEs or FCEs through an outside 

vendor, based solely on the basis of objective, professional criteria, and without 

regard to the results of previous IMEs or FCEs conducted by such individuals. 

f. Professional Certification. The Companies affirm and shall continue their existing 

practice of requiring each clinical, vocational, and medical professional (a 

"Professional") employed by the Companies to (a) execute the "Statement Regarding 

Professional Conduct", found at Exhibit E, which includes a commitment to provide 

fair and reasonable evaluations concerning all available medical, clinical, and/or 

vocational evidence, both objective and subjective, bearing on impairment; and (b) 

certify that he or she has reviewed all medical or vocation information bearing on 

impairment that has been provided by the Companies to that Professional for review 

prior to issuing his or her opinion where such opinion will be used by the Companies 

in making any occupational or adverse liability determination as to a claimant's 

impairments. 

g. Providing Medical, Clinical, and/or Vocational Evidence. The Companies affirm and 

shall continue their existing process that claim personnel, in soliciting evaluations of 

claimant impairment by Professionals (employed by the Companies or otherwise), 

5 
shall provide to each such Professional all available medical, clinical, and/or 

vocational evidence in the Disability Claim File (defined below at paragraph B.8), 

both objective and subjective, concerning impairment. 

2. Affirmations. The Companies affirm that: (i) the Companies' processes prohibit 

attempting to influence in-house physicians or an IME or FCE in connection with such 

Professional's opinion concerning the medical evidence or medical condition relating to a 

claimant; (ii) the Companies do not evaluate claim personnel for promotion, retention, or any 

other purpose on the basis of any claim outcome (or, aside from productivity considerations, any 

number of claim outcomes); and, (iii) the Companies do not consider any claim outcome (or, 

aside from productivity considerations, any number of claim outcomes) in determining any 

component of compensation for claim personnel. The Companies further affirm that they will 

not change any of these processes except in consultation with the Monitoring States. 

3. Training. The Companies' claim personnel shall be provided appropriate training 

designed to educate them on the responsibilities arising from the changes included in paragraph 

B.l as well as the objectives outlined in paragraph B.l.d of this Agreement. Emphasis in such 

training shall be placed on concerns raised in the Examinations and the corrective measures set 

forth in this Agreement. This training will include specific instruction on recognizing the special 

function that medical professionals perform in assessing medical information concerning 

claimants. Furthermore, the training will confirm the continuing force ofthe Companies' 

processes affirmed in paragraph B.2. 

4. Remediation Program. The Companies shall conduct a Remediation Program 

("Remediation Program") in which, as described more fully in Exhibit F, the Companies 

enhanced claim procedures as set forth in this Agreement, will be applied to certain claims 

denied during the Remediation Period (defined in Exhibit F). 

5. Monitoring of Compliance. The Monitoring States, in cooperation with the 

Participating States, shall monitor compliance with this Agreement and the Remediation 

Program and shall apprise other Participating States of the results of such monitoring as may be 

appropriate. Such monitoring will include review of randomly sampled Disability Claim Files 

(defined below in paragraph B.8) denied, adversely terminated, and/or appealed on or after 

January 1, 2013 for claimants residing in the Participating States. The purpose ofmonitoring is 

to review claims handling on a going forward basis and to establish productive dialogue between 

the Monitoring States and the Companies in preparation for re-examination (see paragraph C.2. 

below). Accordingly, though corrective action may be required, no sanction will be imposed by 

the Participating States should monitoring disclose any claims that may have been erroneously 

handled. 

6 
6. Quality Assessment Team. For purposes of monitoring the implementation ofthe 

provisions of this Agreement, the Companies shall establish an internal Disability Claim Quality 

Assessment Team, which will consist often full-time dedicated employees, with an average 

experience level of eight years in the disability insurance industry. The Companies' Policies and 

Procedures Manager will serve as the primary lead for the team, handling all oversight and 

project-related functions. This team shall be in effect throughout the duration of the ongoing 

Quarterly Monitoring, as described in paragraph B.7 below. 

A Management Advisory Group will also be established to provide additional support and 

direction to the Disability Claim Quality Assessment Team on topics ranging from claim specific 

scenarios to more global topics such as ensuring if applicable policies and procedures and/or 

Training materials should be modified. The Management Advisory Group will include the 

following representatives ofthe Companies: VP of Disability Operations; Group Claims 

Counsel; Director, Total Quality Management; and Director, Policies and Procedures. 

7. Quarterly Monitoring. For purposes of discussing the results of the Companies' 

internal Disability Claim Quality Assessment (described in paragraph B.6), the results ofthe 

random sampling provided for in paragraph B.5, the Remediation Program, and the Companies' 

compliance with this Agreement, the Monitoring States, or their designees, shall meet with the 

Companies' Management Advisory Group on a quarterly basis beginning on a date not earlier 

than sixty (60) days after the Effective Date and continuing through the commencement of the 

re-examination described in paragraph C.2. The Companies will provide to the Monitoring 

States a consolidated report of reassessed claims pursuant to the Remediation Program and any 

remedial action taken to determine and pay additional benefits where due, based on the 

application of the enhanced claim procedures set forth in this Agreement. The Companies will 

also consolidate the findings of the Disability Claims Quality Assessment Team into a report 

which will be delivered to the Monitoring States monthly. Any comments or observations from 

the Monitoring States regarding these findings will be furnished to the Companies in writing 

monthly. All findings, actions, and outcomes will be recorded and tracked by the Companies. A 

summary statement of each monthly review period will be provided to the Monitoring States in 

writing prior to each meeting. These meetings will be conducted in person -- though Monitoring 

States may, in their sole discretion, elect to participate telephonically-- to review the previous 

quarter's findings and discuss the overall direction and progress of the Companies' compliance 

with the terms of this Agreement. 

8. Disability Claim Files. A disability claim file shall include all documents relating to 

a claim history and/or decision, including but not limited to correspondence, medical records, 

vocational records, forms, internal memoranda and internal communications (including e-mail 

communications), and copies of the documentation and written explanation contemplated under 

paragraphs B.l.a and B.l.c above, which shall be maintained in the claim file either in a paper 

file or in electronic form. 

7 
c. Other Provisions 

1. This Agreement shall be governed by and interpreted according to the laws of the 

Commonwealth of Pennsylvania, excluding its conflict of laws provisions. 

2. The Monitoring States will conduct a re-examination of the issues addressed by this 

Agreement twenty-four months after the Effective Date, or at such earlier date as may be agreed 

upon by the Companies and the Monitoring States. The Monitoring States will make all 

reasonable efforts to complete such re-examination within six months of its commencement. 

The re-examination will review the Companies' LTD claims handling practices in the 

Participating States for compliance with this Agreement. This re-examination shall be conducted 

in accordance with the National Association oflnsurance Commissioners' Market Regulation 

Handbook, Volume 1. The Participating States shall not conduct independent market conduct 

examinations of the Companies' LTD claim practices until after the Monitoring States complete 

such re-examination. Any claim files examined by the Monitoring States in connection with the 

re-examination of the Companies described in this Paragraph shall not be the subject of any 

future market conduct examinations ofthe Companies by any of the Participating States. 

3. The reasonable costs ofthe Monitoring States for outside services incurred in 

monitoring the Companies' compliance with this Agreement, reviewing the Companies' conduct 

of the Remediation Program, and in conducting the re-examination contemplated by paragraph 

C.2 shall be paid by the Companies. The Companies will also pay each of the five Monitoring 

States a fee of $150,000, payable in two equal annual installments; one within fifteen (15) days 

of the Effective Date and the second on the first anniversary of the Effective Date. 

4. This Agreement shall remain effective until the completion of the re-examination 

referenced in paragraph C.2 above. Except as set forth in paragraph C.5 below, this Agreement 

and its provisions terminate for all purposes pursuant to this paragraph C.4. 

5. Notwithstanding the termination of this Agreement to the extent provided in 

accordance with paragraph C.4 above, this Agreement shall survive as to the following 

provisions, which also individually survive: paragraphs B.l.a through B.l.g (inclusive); 

paragraph B.2; and paragraph B.8 (insofar as it describes the content of a Disability Claim File.) 

6. Neither this Agreement, the Remediation Program, nor any related negotiations, 

statements or court proceedings shall be offered by the Companies or the Participating States as 

evidence of or an admission, denial or concession of any liability or wrongdoing whatsoever on 

the part of any person or entity, including but not limited to the Companies; as a waiver by the 

Companies of any applicable defenses, including without limitation any applicable statute of 

8 
limitation or statute of frauds; or as a waiver by the Commissioner of any regulatory authority 

regarding the matters addressed in the Examination. 

7. This Agreement does not constitute an admission of liability, violation, or 

wrongdoing by the Companies and the Companies expressly deny that any of their actions or 

alleged actions were knowingly committed or represented a pattern and/or business practice that 

would violate the insurance unfair trade practice laws, claims settlement laws, or any other 

applicable statutes or regulations of any of the Participating States. 

8. This Agreement is entered after discussion and in order to avoid the expense, 

uncertainty and distractions of litigation. The Participating States and the Companies agreed to 

enter into this Agreement solely for the purpose of reaching a compromise settlement without the 

need for a hearing or further administrative action. 

9. This Agreement (or its Exhibits) may be amended by the Participating States and the 

Companies at any time. All such amendments to this Agreement shall be in writing. 

D. Remedies 

1. Within fifteen ( 15) days of the Effective Date, the Companies shall pay the California 

Commissioner of Insurance a fine of $500,000, the Maine Superintendent of Insurance a fine of 

$175,000, and the Massachusetts Commissioner of Insurance a fine of $250,000. 

2. The Companies and the California Commissioner of Insurance have entered into a 

separate agreement to address the California-specific issues arising from the 2006 California 

Examination, the 2009 Stipulation and Waiver Agreement, and the 2010 California 

Re-Examination. 

3. If the Monitoring States determine after conducting the re-examination of the 

Companies, as described in paragraph C.2, above, that the Companies have not complied 

materially with the terms of this Agreement, they may assess a fine payable to the Participating 

States. The Companies retain all rights under law, without limitation, to contest the basis for and 

assessment of any such fine. Any fine imposed pursuant to this paragraph shall be allocated 

among the Participating States at their sole discretion. 

4. The Participating States retain the right to impose any regulatory penalty otherwise 

available by law, including fines, with respect to the Companies' willful violation of the terms of 

this Agreement or other violations of the law. The Companies retain all rights under law, 

without limitation, to contest the basis for an assessment of any such regulatory penalties and 

fines. 

9 
LIFE INSURANCE COMPANY OF NORTH CONNECTICUT GENERAL LIFE 

AMERICA 

BY: ~~~ 

ITs: 'Yred d-ent 

CIGNA HEALTH AND LIFE INSURANCE 

COMPANY 

BY: f'Y\~-:::; ~ f·~ 

ITs: W{eS>ickvt± 

DATED: Mcu__tR \Y I '10(~ 

CONNECTICUT INSURANCE 

DEPARTMENT 

BY: 

ITS: 

DATED: 

MAINE BUREAU OF INSURANCE 

BY: 

ITS: 

DATED: 

10 

INSURANCE COMPANY 

BY: ~~J ~~ 

ITS: Gt e?5) d_e nt 

DATED: hrufR IY I 20 13 

CALIFORNIA DEPARTMENT OF 

INSURANCE 

BY: 

DATED: A o 7 1 J, 

1 

2 ~ ( 1 

MASSACHUSETTS DIVISION OF 

INSURANCE 

BY: 

iTS: 

DATED: 

PENNSYLVANIA INSURANCE 

DEPARTMENT 

BY: 

ITS: 

DATED: 
LIFE INSURANCE COMPANY OF NORTH 

AMERICA 

BY: ~ ~~ Y'vrV--~ 

ITs: -Pce:51 cient 

DATED: KCl\cl. l~ I j__Ol3 

CIGNA HEALTH AND LIFE INSURANCE 

COMPANY 

BY: /)fu___, ,j )~, 

ITS: \?{£S>)cleltrt 

oATED: HrucR \'j, '10\3 

CONNECTICUT INSURANCE 

CONNECTICUT GENERAL LIFE 

INSURANCE COMPANY 

BY: ~~ ~J ~-~· 

ITS: C?(0oJ cW n±~---

DATED: hilleR. ll\ l 20 13 

CALIFORNIA DEPARTMENT OF 

INSURANCE 

BY: 

ITS: 

DATED: 

MASSACHUSETTS DIVISION OF 

DEPARTMENP .· J w . '' INSURANCE 

BY: ;//~ j':_J(~- ( BY: ---------

ITS: (d ll1r11t ~J'I~(__ ITS: 

DATED: ~--/0--d DATED: 

MAINE BUREAU OF INSURANCE PENNSYLVANIA INSURANCE 

BY: 

ITS: 

DEPA~NT : IJ(_l_ , 

BY: ·~ ITS: C'!eotfllt~l ~ 

DATED: DATED: J ·/5 .. /3 

10 
. '•,• .. 

LIFE INSURANCE COMPAN"Y OF NORTH CONNECTICUT GENERAL LIFE -~ 

AMERICA INSURANCE COMPANY t~ r,, 

l ~~ ~ ~-~ ~~ I' 

BY: BY: ~-~ ,, 

@-e0"c1Pt± : 1 ITS: Yres.ri d-ent ITS: I 

l 

l DATED: H..c:li~l:t 1._0l3 DATED: "Hcuc.l \lL 20l3 j . I 

CIGNA HEAL m AND LIFE INSURANCE CALIFORNIA DEPARTMENT OF I. 

COMPANY INSURANCE I 

I· 

~---~ ~ f; 

BY: BY: I 

I 

· \Y.{esricle.vrt io 

ITS: ITS: ~ ~ DATED: tkuc£ \L\1 '10\3 DATED: ~ ·H 

MASSACHUSETTS DIVISION OF 

t. 

CONNECTICUT INSURANCE ~~ 

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DEPARTMENT INSURANCE t ... 

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; 

BY: BY: '.1., 

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ITS: iTS: i IAMVh ';;-;;, o !1 e. V" '" 

DATED: DATED: M?Yj 8, 'ZDI3 

MAINE BUREAU OF INSURANCE PENNSYLVANIA INSURANCE 

BY: D~~ BY: ~~ ~ ~~ 

ITS: ITS: . ~till~/~~ 

DATED: DATED: 3·L5 .. L~ r 

10 
LIFE INSURANCE COMPANY OF NORTH 

AMERICA 

BY: ~~~ 

ITS: ~d-ent 

CIGNA HEALTH AND LIFE INSURANCE 

COMPANY 

BY: fhr\_t~~ ~ 

ITS: \£f e?d ckvrt 

CONNECTICUT INSURANCE 

DEPAR1MENT 

BY: 

ITS: 

DATED: 

MAINE BUREAU OF INSURANCE 

10 

CONNECTICUT GENERAL LIFE 

INSURANCE COMPANY 

BY: ~~~~ 

ITS: C?reisi cW rrt 

DATED: Hruill. \Y ( w 13 

CALIFORNIA DEPARTMENT OF 

INSURANCE 

BY: 

ITS: 

DATED: ------------------

MASSACHUSETTS DIVISION OF 

INSURANCE 

BY: 

ITS: 

DATED: ------------------ PENNSYLVANIA INSURANCE 

gy, 

DEPAr;t~~!J() -~ , 

ITS: ~1'11~/&lQ.C 

DATED: J ·/5--/~ 
LIFE INSURANCE COMPANY OF NORTH 

AMERICA 

BY: ~ ~ t'\!Vv-v~ 

ITs: Yff<;)i dent 

DATED: ~Ctick_l~ 1 1.-..0l~ 

CIGNA HEALTH AND LIFE INSURANCE 

COMPANY 

BY: f'rlu_,-:::; --._j ~~ 

ITS: (?{£srickvrt 

DATED: t\ru_~ \L\ 1 '10\3 

CONNECTICUT INSURANCE 

DEPARTMENT 

BY: 

ITS: 

DATED: 

MAINE BUREAU OF INSURANCE 

BY: 

ITS: 

DATED: 

10 

CONNECTICUT GENERAL LIFE 

INSURANCE COMPANY 

BY: ~~~ ~~ 

ITS: C?r-ec& den± 

DATED: Hcu.cR .. iY l 20 13 

CALIFORNIA DEPARTMENT OF 

INSURANCE 

BY: 

ITS: 

DATED: 

MASSACHUSETTS DIVISION OF 

INSURANCE 

BY: 

ITS: 

DATED: 

PENNSYLVANIA INSURANCE 

BY: 

DEPAff~= ·~ ()/}_ , 

ITS: C!eotfl11~1&\ll..L 

DATED: 3 ·/S··/~ 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC#67369 

On behalf of the Alabama Department of Insurance, I, Jim Ridling as Commissioner of 

Insurance, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 

13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

Date:---===O~S.:....L~...!:...'cj.---!/ ~~/-=-IJ ___ _ 
AK DOl MCE #13-01 

PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA ITER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of Department of Commerce, Community, & Economic Development, 

Division of Insurance, I, Bret S. Kolb, as Director, hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

DEPARTMENT OF COMMERCE, 

COMMUNITY, & ECONOMIC 

DEVELOPMENT, DIVISION OF 

INSURANCE 

Title: Director, Division of Insurance 

Date: May 21, 2013 
5023542505 AZDIJ I CDNSUtvlERS 

PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEME7'L' AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (flk/a AJta Health and Lit~· lnsmance Company) 

Philadelphia, Pennsylvania 

NAlC # 65498, 63308 

Bloomfield. Connecticut 

NAIC # 67369 

On behalf of ARIZONA DEPARTMENT OF INSURANCE, I, GERMAINE L. 

PAGE 02/02 

MARKS, As DIRECTOR, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13, 2013 by and between the abuve-named Companies and the regulatory 

agencies named therein, 

ARIZONA DEPARTMENT OF INSURANCE 

By: r,~~e i! f"tcvJ:~ 

Title: Director 

Date: ~'-.0--, l( 1 ?Ot3 

/ / 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f!k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the State of Arkansas, I, Ashley Fisher, as Market Conduct Manager, 

hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 2013 by 

and between the above-named Companies and the regulatory agencies named therein. 

ARKANSAS INSURANCE 

DEP~~=- Q .. By:---4:~~::::::o-L----------

Title: l'v\oJuf ~ M{f" 

Date: V (r/1.7 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Colorado Division oflnsurance, I, Jim Riesberg, as Insurance Commissioner, 

hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 2013 by 

and between the above-named Companies and the regulatory agencies named therein. 

Colorado Division of Insurance 

By ~~~ Title: Insurance Commissioner 

Date: day 3o

7 

Zo 1 J 
PARTICIJ>ATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS 0~ 

DISABILITY INCOME INSUl\ANCE CLAIM HANDLINGJ~JsA(,~.IlC:ES. 

IN THE MATTER OF 

l-ife Insurance Company ofNorth America, Connecticut General 

Life Insurance Company. and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Compai1y) 

Philadelphia, Pennsylvania 

NAlC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfofthe Delaware Department of Insurance, I, Karen Weldin Stewart, CIR-ML, 

as Insurance Commissioner for the State of Delaware, hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

DELAWARE DEPARTMENT OF 

INSURANCE<,. 

. ,/~·~-.- ... -·~-·-·~·· 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDUNG_PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company ( t/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf oft he District of Columbia Department of Insurance, Securities and Banking, 

I, Margaret Schruender, as Deputy Commissioner, hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfof[STATE INSURANCE REGULATORY AGENCY], I, [EXECUTING 

OFFICIAL], as [EXECUTING OFFICIAL'S TITLE], hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

[STATE INSURANCE REGULATORY 

AGENCY] I 

I 
'~ · PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA TIER OF. 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

C~~pany (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC# 67369 

On behalf of the Georgia Insurance Department, I, Ralph T. Hudgens, as Commissioner 

of Insurance of the State of Georgia, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13, 2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

Title: Commissioner oflnsurance 

Date: tJ6{1tJ(zol3 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

· NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of Idaho Department of Insurance, I, Georgia Siehl, as Bureau Chief/Chief 

Examiner, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 

13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

IDAHO DEPARTMENT OF INSURANCE 

Title: BUREAU CHIEF/CHIEF 

EXAMINER 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/kla Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfofthe ILLINOIS DEPARTMENT OF INSURANCE, I, Andrew Boron, as 

Director, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 

2013 by and between the above-named Companies and the regulatory agencies named therein. 

[STATE INSURANCE REGULATORY 

AGENCY] 

By: dz[dwti/ !JZ,wz/ 

Title: Director _________ _ 

Date: May 28, 2013 _______ _ 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of Indiana Department of Insurance, I, Stephen W. Robertson, as 

Commissioner, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated 

May 13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

Indiana Department of 

Title:_~::.._:_ffi_fr\_\--'S~'---'----=---:.~---=----

Date:_-:J_lA._'f\_-..Q_ __ \ _5 :)-+----"2.-£.--/ O---=------a_J3= 
PARTICIPATING STATE ADOPTION 

of 

REGULA TORY SETTLEMENT A(;UEEMENT 

TARGETED MARKET CONDUCT EXAMINATJONS OF 

1}1~\!.HlJTY INCOMF;..INSURANCE C~Ll\IM HANDLI~QPISl1.~~TlCE~ 

IN THI~: l'v1AI"T'ER OF 

LiF: ln~urance Company of North America. Connecticut (len<:ral 

LJk Insurance Company. and CIUNA Beal!h and Lite lnsuranCl' 

Company (f!k/a Alta Health and Life Insurance Compan_y} 

Philadelphia, Pennsylvania 

NAIC # 65498. 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On he half of the Iowa !nsunmcc Division. L Rosanne l'v1cad, as kl\Y<l Assi'>tanl I nsuL1t1C(~ 

(dmmissinncr. hcn:b) adupt. agree. and approve the Regulatory Settlement :\gn:emcnt da1cd 

l \, 20! .~ and bctvveen the abo\e-named Companies and Lhe regulatory ngcncics twn·lt~d 

lhe.n:in. 

'fitle: Assistant lnsurance ('ommissioner 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA TIER OF 

Life Insurance Company ofNo11h America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Kansas Insurance Depm1ment I, Sandy Praeger, as Conm1issioner of 

Insurance, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 

13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

Title: Commissioner of Insurance 

Date:-----~~ ;('--"J~r-;1-j--'---/'*Lj ____ _ 

I I 
PARTICIPATING STATE ADOPTION 

OF 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF: 

LIFE INSURANCE COMPANY OF NORTH AMERICA, 

CONNECTICUT GENERAL LIFE INSURANCE COMPANY, 

and CIGNA HEALTH AND LIFE INSURANCE COMPANY 

(f/k/a ALTA HEALTH AND LIFE INSURANCE COMPANY) 

Philadelphia, Pennsylvania 

NAIC NO. 65498, 63308 

Bloomfield, Connecticut 

NAIC NO. 67369 

On behalf of the Commonwealth of Kentucky, Department of Insurance, I, Shaun T. 

Orme, General Counsel, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement date May 13, 2013, by and between the above-named companies and the 

regulatory agencies named therein. 

COMMONWEALTH OF KENTUCKY 

DEPARTMENT OF INSURANCE 

By:--:::~-=---...:........:oo~-===::;------

Title :_~Ct----a#->.t:.-c..afk!~_.....,C.,...Q,"""C"""'u..n ..a.:wi::.....L-____ _ 

Date: __ (9,___;:_/t...:......( .,___? -+-/2""""""ZAJ~t3:;....__ ___ _ 
PARTICIPATING STATE ADOPTION 

of 

REGULA TORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA TIER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (£1k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Louisiana Department of Insurance, I, James J. Donelan, as 

Commissioner of Insurance, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13, 2013 by and between the above-named Companies and the regulatory 

agencies named therein. 
The PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the State of Maryland Insurance Administration, I, Therese M. Goldsmith, 

as Insurance Commissioner, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13, 2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

Maryland Insurance Administration 

200 St. Paul Place, Suite 2700 

Baltimore, MD 21202 

THERESE M. GOLDSMITH 

~ER 

Thomas L. Marshall 

Associate Commissioner, 

Compliance & Enforcement 

Date: June, 27, 2013 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA TIER OF 

Life Insurance Company ofNm1h America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC#67369 

On behalf of the State of Michigan, Department of Insurance and Financial Services, I, R. 

Kevin Clinton, as Director, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13,2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

STATE OF MICHIGAN 

DEPARTMENT OF INSURANCE AND 

FINANCIAL SERVICES 

By: ~.\G R. Kevin Clinton .. . ~ 

Title: Director 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS Of 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Minnesota Department of Commerce, I, Mike Rothman as 

Commissioner, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated 

May 13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

Mi~~te~~~~~/1erce 

By:,/11:/-cJ--O~c#---- / ,4 . . 

Title:~~ 

Date: 7-22- I 3 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Mississippi Insurance Department, I, Mark Haire, as Deputy 

Commissioner, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated 

May 13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

MISSISSIPPI INSURANCE DEPARTMENT 

By:~k\~SL 

Title:~ C,.,.~ 

Date: ' -{ q- l3 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfof[STATE INSURANCE REGULATORY AGENCY], I, [EXECUTING 

OFFICIAL], as [EXECUTING OFFICIAL'S TITLE], hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

[STATE INSURANCE REGULATORY 

AGENCY] 

<-)~--

Title: Director, DIFP 

Date: 6 I 1 9 1 1 3 
PARTICIPATING STATE ADOPTION 

of 

REGULA TORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (t/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Office of the Commissioner of Securities and Insurance, Montana State 

Auditor (CSI), Monica J. Lindeen, as Commissioner of Securities and Insurance, Montana State 

Auditor, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 

2013, by and between the above-named Companies and the regulatory agencies named therein. 

Title: Commissioner ofSecurities and 

Insurance. Montana State Auditor 

Date: July 8, 2013 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f!k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the State of Nebraska Department oflnsurance, I, Bruce R. Ramge, as 

Director of Insurance, hereby adopt, agree, and approve the Regulatory Settlement Agreement 

dated May 13, 2013 by and between the above-named Companies and the regulatory agencies 

named therein. 

STATE OF NEBRASKA 

DEPARTMENT OF INSURANCE 

By:~elf~ 

Title: .{), l:tX-b.r 

Date: S-_;]o.- ~L3 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA TIER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (:ti'k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC# 67369 

On behalf of STATE OF NEVADA, DEPARTMENT OF BUSINESS AND 

INDUSTRY, DIVISION OF INSURANCE, I, SCOTT J. KIPPER, as NEVADA 

COMMISSIONER OF INSURANCE, hereby adopt, agree, and approve the Regulatory 

Settlement Agreement dated May 13, 2013 by and between the above-named Companies and the 

regulatory agencies named therein. 

STATE OF NEVADA, 

DEPARTMENT OF BUSINESS AND INDUSTRY, 

DIVISION OF INSURANCE 

By:~ 

Title: Nevada Commissioner oflnsurance 

Date: ::::r;:_ tt t". 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MAlTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (t/kfa Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfofthe New Hampshire Insurance Department, I, Roger A. Sevigny, as 

Commissioner, hereby adopt, agree, and approve the Regulatory Settlement Agreement dated 

May 13, 2013 by and between the above-named Companies and the regulatory agencies named 

therein. 

Title: Insurance Commission~r , ___ _ 

Date: /-1(-/3 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA ITER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the State of New Jersey Department of Banking and Insurance I, Kenneth E. 

Kobylowski as Commissioner of the New Jersey Department of Banking and Insurance hereby 

adopt, agree, and approve the Regulatory Settlement Agreement dated May 13,2013 by and 

between the above-named Companies and the regulatory agencies named therein. 

Title: Commissioner 
l'ARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED Mt\.RKET CONDUCT EXAMINATIONS OF 

J)ISABILJTY INCOMI~ INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth Ameriea, Connecticut General 

Life Insurance Company, and CIGNA Health and Life 'Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of New Mexico Insurance Division, Public Regulation Commission, I, Mark 

Jordan, as Chief Examiner, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13,2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

[STATE INSURANCE REGULATORY 

AGENCY] 

By: --1-:h'~----I.,.<"F~--=-=· 

Date: June 24,2013 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insw·ance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the New York State Department of Financial Services, I, Robert H. Easton, 

as Executive Deputy Superintendent, Insurance Division, hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

NEW YORK STATE DEPARTMENT OF 

FINANCIAL SERVICES 

Title: __ t~_<-v_\M_· _D-'to.._~-+-~-+--\-'"" ..... ~-~---'-' ~-~vf~c..t; .:..1,..:..:...:} ~ 't>-V\~ II) v"" 

Date: ~~1-~l \) 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (t/kta Alta Health and Life Insurance Company) 

Philadelphia. Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the North Dakota Insurance Department. I, Adam Han1m, as North Dakota 

Insurance Commissioner, hereby adopt. agree, and approve the Regulatory Settlement 

Agreement dated May 13,2013, by and between the above-named Companies and the regulatory 

agencies named therein. 

North Dakota Insurance Department 

By: 

Title: Insurance C9rnmissioner 

Date: Junel9.2013 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the State of Ohio, Department of Insurance, I, Mary Taylor, as Lt. 

Governor/Director, hereby adopt, agree, and approve the Regulatory Settlement Agreement 

dated May 13, 2013 by and between the above-named Companies and the regulatory agencies 

named therein. 

Ohio Department of Insurance 

By:7'} ~~/(::~.:._- (/ 

Title: Lt. Governor/Director 

Date: &J/~J/:a r , 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of Oklahoma, I, Paul Wilkening, as First Deputy Insurance Commissioner, 

hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 2013 by 

and between the above-named Companies and the regulatory agencies named therein. 

Date: 5123113 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 62308 

Bloomfield, Connecticut 

NAIC# 67369 

On behalf of Oregon Department of Cons·umer and Business Services, Insurance 

Division, I, Lou Savage, as the Insurance Commissioner, hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

II 

II 

II 

Title: Insurance Commissioner 

Date: JUN 1312013! 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Rhode Island Department of Business Regulation, Division of Insurance, 

I, Joseph Torti III, as Superintendent of Insurance, hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

Rhode Island Department of Business 

Regulation, Division of Insurance 

By: t= ~~1E_ 

Title: Superintendent of Insurance 

i 7 

Date: June Ll. 2013 

• 
PARTICIPATING STATE ADOPTION 

of 

REGCL\TORY SETTLEMENT AGREEl\'IENT 

TARGETED MARKET CONDUCT EXAivllNATlONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of South Carolina Department of Insurance, I, lvTichael Bailes, as Market 

Regulation Supervisor, hereby adopt, agree, and approve the Regulatory Settlement Agreement 

dated May l 3, 2013 by and between the above-named Companies and the regulatory agencies 

named therein. 

South Carolina Depmtment of Insurance 

By: ~Ct(J\.$_.J!~v\'lUh-_·· __ 

/. . 

Title: lJav /6:J 12tjui(:tJ:··ion uupcrVI ~fY 

Dak: 1·/\:;:t)\o 
south dakota department of 

labor 

regulation 

PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

Division of I nsu ranee 

Tel: 605.773.3563 

Fax: 605.773.5369 

www.dlr.sd.gov/insurance 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the South Dakota Division of Insurance, I, Merle Scheiber, as Director, 

hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13,2013 by 

and between the above-named Companies and the regulatory agencies named therein. 

South Dakota Division of Insurance 

Merle Scheiber, Director, South Dakota 

Division of Insurance 

Date: tb -d.f-/3 ---------------------------

445 East Capitol Avenue • Pierre, SD 57501-3185 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of TENNESSEE, I, JULIE MIX MCPEAK as COMMISSIONER, hereby 

adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 2013 by and 

between the above-named Companies and the regulatory agencies named therein. 

TENNESSEE DEPARTMENT OF 

COMMERCE & INSURANCE 

By: bt. ~ 110JAt 

Title: f!omtlft; ?Lifltr 

Date: ~d//;B I 
.2639 

PARTICIPATING STATE ADOYfiON 

of 

REGULATORYSETTLE~NTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA TIER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alm Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC#67369 

On behalf of [STATE INSURANCE REGULATORY AGENCY], I, [EXECUTING 

OFFICIAL], as [EXECUTING OFFICIAL'S TITLE], hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

[STATE INSURANCE REGULATORY 

AGENCY] . 

By·~ Tit~= ~~ l r15(_tro:nce_ 

Date: l / I l / 13 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MA ITER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (flk/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfof[STATE INSURANCE REGULATORY AGENCY], I, [EXECUTING 

OFFICIAL], as [EXECUTING OFFICIAL'S TITLE], hereby adopt, agree, and approve the 

Regulatory Settlement Agreement dated May 13, 2013 by and between the above-named 

Companies and the regulatory agencies named therein. 

[STATE INSURANCE REGULATORY 

AGENCY] '/ 

By: -,; L t If. , 176- .,.~ 

Title: /~ ).krl L/f~ 

Date: f#4U~'~ 

v . 7--l·ll 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 62308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Vermont Department of Financial Regulation, I, Christina R. Rouleau, 

as Director of Market Regulation, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13,2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

VERMONT DEPT. OF FINANCIAL 

REGULATION 

By: ~ .. 

Christina R. Rouleau 

Title: Director of Market Regulation 

Date: May 21,2013 
COMMONWEALTH OF VIRGINIA 

STATE CORPORATION COMMISSION 

IN THE MATTER OF 

LIFE INSURANCE COMPANY OF NORTH AMERICA, 

CONNECTICUT GENERAL LIFE INSURANCE COMPANY, and 

CIGNA HEALTH AND LIFE INSURANCE COMPANY 

Ex Parte: In the matter of Approval of a 

Regulatory Settlement Agreement 

between the Life Insurance Company ofNorth America, 

Connecticut General Life Insurance Company, and CIGNA 

Health and Life Insurance Company and the Insurance 

Commissioners or Superintendent of the States of 

California, Connecticut, Maine, Massachusetts, and 

Pennsylvania, for and on behalf of the 

Virginia State Corporation Commission's Bureau of Insurance 

CASE NO. INS-2013-00155 

PARTICIPATING REGULATOR ADOPTION 

ON THIS DAY this matter came before the Virginia Bureau of Insurance, State 

Corporation Commission ("Bureau") for consideration and, upon consideration thereof, the 

Commissioner oflnsurance finds: 

1. Life Insurance Company of North America, Connecticut General Life Insurance 

Company, and CIGNA Health and Life Insurance Company (formerly known as Alta 

Health and Life Insurance Company) (collectively, the "Companies") are licensed to 

transact the business of insurance in the Commonwealth ofVirginia. As affecting the 

Commonwealth of Virginia, the Bureau has jurisdiction over the subject matter of this 

proceeding and the Companies. 

2. The Insurance Commissioners or Superintendent from the States of California, Maine, 

and Massachusetts, (collectively, "Lead Regulators") conducted targeted market conduct 

examinations of the Companies to review the Companies' disability income claim 

handling practices. 

3. A settlement has been presented to the Bureau, the terms of which are set forth in a 

Regulatory Settlement Agreement ("Agreement") that has been signed by the Companies 
and the Lead Regulators. The Companies understand that they have a right to a hearing 

in this matter, and have agreed to waive such right, in accordance with the Agreement. 

4. The Bureau expressly adopts, agrees and approves this Agreement as a fair and proper 

disposition of the matters addressed herein. 

THEREFORE, IT IS DIRECTED that the Agreement dated May 13,2013, and attached 

hereto as "Exhibit A" be, and is hereby approved, adopted, and fully incorporated herein by 

reference. The Companies shall initiate compliance with all the terms and conditions of the 

Agreement as incorporated herein. 

A COPY hereof shall be filed with the Clerk ofthe Commission and thereby placed in Case 

No. INS-2013-00155. 

J~cqJiine K. Cunnin~am 

':Commissioner of Insurance 

Bureau of Insurance 

State Corporation Commission 

Commonwealth of Virginia 

2 

Date 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalfofWashington state Office ofthe Insurance Commissioner, I Mike Kreidler, as 

Insurance Commissioner, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13, 2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

Title: Insurance Commissioner 

Date: June 6, 2013 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company ofNorth America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of West Virginia Offices of the Insurance Commissioner, I, Michael D. Riley, 

as Insurance Commissioner, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13, 2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

West Virginia Offices of the Insurance 

Commissioner / ,!1 / 

By: flf d. ~/tj 7Jl_ '] 

Title: Insurance Commissi/r 

Date:_.L._/ft~~+-~A.....L/------:;~. ~Z=--D_I._'-1 __ I I 
PARTICIPATING STATE ADOPTION 

of 

REGULATORY SETTLEMENT AGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (£'k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Wisconsin Office of the Commissioner of Insurance, I, Theodore Nickel, 

as Commissioner of Insurance, hereby adopt, agree, and approve the Regulatory Settlement 

Agreement dated May 13,2013 by and between the above-named Companies and the regulatory 

agencies named therein. 

~ 

Wisconsin Office of the Commissioner of 

' Title: E/l .F ,;;,~£ 

I>ate: ~ • "'~ 
PARTICIPATING STATE ADOPTION 

of 

REGULATORYSETTLEMENTAGREEMENT 

TARGETED MARKET CONDUCT EXAMINATIONS OF 

DISABILITY INCOME INSURANCE CLAIM HANDLING PRACTICES 

IN THE MATTER OF 

Life Insurance Company of North America, Connecticut General 

Life Insurance Company, and CIGNA Health and Life Insurance 

Company (f/k/a Alta Health and Life Insurance Company) 

Philadelphia, Pennsylvania 

NAIC # 65498, 63308 

Bloomfield, Connecticut 

NAIC # 67369 

On behalf of the Wyoming Department oflnsurance, I, James Mitchell, as Staff Attorney, 

hereby adopt, agree, and approve the Regulatory Settlement Agreement dated May 13, 2013 by 

and between the above-named Companies and the regulatory agencies named therein. 

WYOMING DEPARTMENT OF INSURANCE 

By: ~ .J 2JJ:J:j{J 

Titleti:ffAttor~ 

Date: ~- /CJ -13 
Exhibit B 

Social Security Awards and Disability Determinations 

Introduction 

A Social Security Disability Income ("SSDI") award by the Social Security Administration 

("SSA") will be given significant weight in a claimant's favor under certain circumstances in 

making a Disability analysis. For that reason, where a claimant has been awarded SSDI benefits, 

the Claim Manager should review the SSA records related to the award and highlight the 

consideration given to the SSDI award and decision in the claim file documentation. The 

Company will make a reasonable effort, consistent with all applicable SSA regulations, manuals, 

and guidelines, to obtain SSA records with the cooperation ofthe claimant, his/her legal 

representative, provider and/or the SSA, but will not delay its consideration of a claim should 

SSA records, despite the Company's reasonable effort, be unavailable for review in a timely 

manner. 

This release provides direction on how SSDI-related information should be gathered and 

considered during the course of your claim evaluation, as well as how that information and 

consideration should be documented to the claim file. 

Procedure 

Affording significant weight to a SSDI award means that the SSA records related to the SSDI 

award are reviewed and consideration of the SSA's judgment that a claimant is disabled for 

SSDI purposes will generally be an essential element of the Disability evaluation under the 

governing Disability contract. There will be exceptions in some circumstances, however, where 

the SSDI award should not be given significant weight and may be less relevant, or of no 

relevance, to our liability determination. For example, the SSDI award may not be an essential 

element of the Disability evaluation where compelling evidence exists that, e.g.: 

• The award is based on the SSA's use or application of internal administrative 

standards that may reduce the standard of proof required for certain claimants, e.g. 

transferability of skills for older claimants, and are inconsistent with the applicable 

Disability policy's proof requirements for Disability; 

• The SSDI award is aged and/or inconsistent with other information relevant to the 

Disability determination, including, e.g. more current medical information and/or 

vocational and financial/earnings information; 
• Where contractual provisions may preclude a claimant from receiving benefits 

regardless of Disability status, e.g. pre-existing conditions, contractual limitations, or a 

claimant's earnings have exceeded the maximum allowed under the policy; 

• Where records relevant to the timing and/or basis of the SSDI determination are not 

otherwise available and the claimant has refused to provide and/or timely respond to the 

Company's reasonable requests for authorization to obtain the SSDI file. 

In addition to these specified exceptions, there may be additional circumstances in which other 

evidence may clearly show that a claimant is not disabled as defined in the policy. An example 

of such evidence would be a situation where a claimant indicates that s/he cannot work and is not 

working, but the claim evaluation reveals that s/he is, in fact, working in an occupation and/or 

performing duties or activities that are inconsistent with his/her stated restrictions and 

limitations. 

In those circumstances where a Claim Manager determines that a SSDI award is of lesser or no 

relevance, the Claim Manager should document the rationale(s) for that determination in the 

claim file. Specifically, upon reaching such a determination, the Claim Manager should: 

• Document the specific information or circumstances supporting the determination 

that the award is of lesser or no relevance in the claim file; 

• Clearly explain to the claimant in writing the basis(es) for the determination that the 

award is of lesser or no relevance. That explanation should include the specific 

information, circumstances and/or policy language relevant to the determination and its 

relation to the Disability liability decision. 

Compelling Evidence: SSDI in Relation to the Disability Claim Decision 

Although the SSA's disability definition uses similar terminology to the standard Any 

Occupation definition in our policies, it is not identical. Claim Managers must review the SSA 

records related to any award determination where SSA records are obtainable with reasonable 

effort and must always apply the Disability definition from the governing policy when making a 

decision on a claim. 

Compelling Evidence - Determining Relevance Based on Policy Language, Limitations or 

Exclusions or Where SSA Processes Differ from Policy Requirements 

Where the Company's policy contains a different definition of Disability (e.g. Own Occ v. Any 

Occ) or a benefit limitation not found in SSDI coverages (e.g. the MIL language discussed 

below), the difference between the wording or application of the policy language in the SSA 

regulations and in the Company's policy provides compelling evidence that will limit or negate 

the relevance ofthe SSDI award. 

II 
For example, if the policy contains a 24-month Mental Illness Limitation (MIL) and the SSA 

award of disability benefits was based on a mental illness condition, the SSDI award will be of 

lesser or no relevance to an adverse claim determination that is based on the 24-month MIL 

provision. Similarly, if the Company's claim determination is based on the fact that the claimant 

is not eligible for coverage or that the Disabling condition was Pre-existing as defined by the 

policy, then the SSDI award will not be relevant. 

Similarly, the Company and the SSA may differ in their consideration of age in certain 

circumstances when determining whether a person is Disabled. For example, in instances that 

involve the transferability of skills for older claimants, the SSA regulations permit and specify a 

more limited analysis than the Company's policies. 

Additionally, the SSA takes a similar, reduced proof approach to certain diagnoses or conditions, 

awarding benefits based solely upon the existence of the diagnosis or condition and presuming 

disability. These types of awards are referred to as compassionate allowances or presumptive 

disabilities. Our policies do not permit such reduced standards of proof, and the Claim Manager 

should continue to evaluate a claimant's Disability under the policy's terms and requirements 

with the medical, vocational and financial proof of loss information available. 

In addition to the consideration of age or presumptive disability, another difference between the 

SSA regulations governing disability determinations and the Company's policies is the 

consideration of part-time work capacity. The SSA generally will only consider the individual's 

ability to perform full-time (8 hours/day) work, while the Company's policies typically require 

an analysis of the claimant's ability to perform part-time work in determining when benefits are 

payable. 

Compelling Evidence - Determining Relevance When There is Inconsistent Medical Information 

or When There is Other Reason to Conclude that the Claimant is Not Disabled 

Medical information and what it tells us about a claimant's level of functionality at the relevant 

time period(s) are critically important to the Disability analysis. Where an SSDI award provides 

relevant insight into the claimant's functional ability, it can be highly relevant to the Disability 

analysis. Where the medical information upon which the award is based is aged, e.g. 6 months or 

older, and/or provides no useful information or insight into the claimant's level of function, it 

will be less relevant. 

In determining the relevance and impact of a SSDI award to the Disability evaluation, the Claim 

Manager should consider and address, as applicable, the following factors, as applicable in 

determining whether the SSDI award provides compelling evidence of Disability: 

• A significant difference between the information reviewed by the SSA and the 

Company. 

Ill 
• A faulty, mistaken or inappropriate analysis of the available evidence by either the 

SSA or the medical resource relied on by the SSA in making its decision. 

• The claimant's condition has changed or improved. 

• The claimant's age, education and economic status. 

• Whether occupations are identified within the claimant's restrictions and limitations 

that are appropriate based upon his or her training, education and experience. 

• Agreement with the Attending Physician (Has the Attending Physician changed 

his/her opinion? Based on what information?). 

• The amount of time since the award decision or the generation of the medical 

information supporting it. 

• Whether SSA has reassessed the claimant's condition since its initial award decision. 

If so, when and what were the results of that reassessment? 

The existence of any one or more of these factors is not an indication that the claimant no longer 

meets the policy's requirements for Disability, but may impact the Claim Manager's 

determination regarding the relevance of the SSDI award. Where these types of factors exist, a 

Claim Manager may reasonably determine that the SSDI award's relationship to the Disability 

determination is less compelling. As a SSDI award is generally an essential element of the 

Disability analysis, the Claim Manager should analyze and address these factors within the 

context of considering the claim file as a whole, reaching out to the claimant, his/her 

representative(s) and treating providers as needed to validate the information obtained, and 

carefully document conclusions in the claim file prior to making the claim determination. 

An inability to obtain the file does not change the weight to be given to an SSDI award, unless 

the claimant who has been awarded SSDI benefits affirmatively indicates that s/he will not 

authorize the Company to obtain the SSA file and/or fails to timely respond to the Company's 

request for such authorization, in which case the Company will not afford significant weight to 

the SSA award. The file documentation should fully record the Claim Manager's efforts to obtain 

the SSDI file. 

Validation oflnformation- Confirming We Have Current Medical Information 

The claimant's medical record and ALJ award letter can contain information helpful in 

determining the reasoning behind the decision to award benefits. For claimants who have chosen 

SSDI representation from our offered expert vendors, the information our vendors initially 

submit to the SSA is provided by CGI and will mirror the information in our claim file. If the 

IV 
vendor appeals the SSDI application to the ALJ/Hearing Level, the vendor may seek additional 

medical information from providers that is independent of the information the vendor initially 

received from CGI. Our SSDI assistance vendors will provide regular reports that indicate if new 

medical information has been gathered or generated during the SSDI appeal process, which may 

be independent ofCGI's records. 

If SSDI has been awarded, to validate that we have up-to-date medical and SSDI information, 

the Claim Manager should check the vendor reports during the course of gathering information 

and compare the recency of the vendor information to the medical in the claim file. If the Claim 

Manager determines there is more current information, s/he should attempt to obtain the current 

medical information and evaluate it accordingly, by: 

1. Contacting the vendor to obtain the information or identify the treatment providers 

who hold the information. 

2. Contacting the claimant (or claimant's representative) to confirm what, if any, 

additional medical records or provider information the SSDI file may contain. This step 

will apply where the claimant either is not represented in the SSDI application process or 

retained his/her own representative. 

3. Reaching out to treating providers to ensure we have all of the available medical 

information, and any assigned restrictions and limitations. 

4. If treatment providers do not timely respond to our requests, request authority from 

the claimant or his/her representative to obtain the SSDI file. 

5. If new medical information is received, proceed with complete medical review. 

6. Document the assessment of the new records and their relation to the claim 

determination in the context of the review of the claim file as a whole. 

SUMMARY 

Disability evaluations are based on conclusions drawn from multiple factors including medical, 

vocational, and financial documentation applied to the provisions of the governing policy. An 

SSDI award and the information related to it should be an element of this analysis. Various 

factors will determine the relevance and impact of a SSDI award to the liability determination. 

The Claim Manager should analyze and address these factors within the context of considering 

the claim file as a whole, and document the file accordingly. 

v 
Exhibit C 

Gathering Medical Information & Documenting 

Conclusions 

Table of Contents 

1. Introduction 

2. Gathering Medical Documentation 

3. Triggers for Gathering Additional Information 

4. Reviewing Medical Information 

5. Evaluating Medical Support of Disability 

6. Evaluating Claims with Co-Morbid or Co-Existing Conditions 

7. Summary 

Introduction 

Standard definition of disability wording requires that disability arise from illness, sickness, or 

injury. Given this, documenting and confirming a claimant's medical status is an important 

component of disability determinations. 

Documenting and confirming medical status involves forming an understanding of functional 

capacity, expected resolution of the disabling condition, and feasibility of return to work. To 

facilitate this process, this release provides guidelines for the following: 

• Gathering relevant credible medical information 

• Utilizing available resources to clarify restrictions and limitations 

• Attempting to resolve discrepancies in medical statements or conclusions 

• Outlining and documenting the medical conclusions on which a disability determination 

may be based 

• Evaluating functional capacity with the presence of co-morbid or co-existing conditions 

As stated above, this release focuses on the medical component of a disability evaluation. It 

does not contemplate issues of eligibility or exclusion, which may otherwise impact a claim 

evaluation. 
Gathering Medical Documentation 

Medical documentation can assist with claim management by providing a better understanding 

of functional capacity, expected resolution of a condition, and feasibility of return to work. 

Relevant medical documentation can be drawn from many sources including, but not limited 

to, the following: 

• Medical records supplied by those providing treatment to the claimant; i.e. - office 

notes, treatment records and plans, clinical findings, medical tests including raw scores, 

pharmacy records 

• Medical texts, articles, and other publications that are considered to be generally 

acceptable sources of medical information 

Along with these most commonly utilized sources, additional information that may assist 

includes but is not limited to: 

• The claimant's own statements, including information gathered during phone calls or 

personal interviews 

• Observations ofthe claimant's activities (personal interviews, surveillance, IME or FCE 

observations) 

• Financial records 

• Data from administrative/regulatory agencies for the purpose of determining the status 

of licensing and/or certification 

Triggers for Gathering Additional Information 

Vague Statements 

Vague statements of impairment made by the treating or certifying physician generally do not 

provide enough detail to make determinations about the nature or degree of functional 

impairment resulting from a claimant's condition(s). Examples include: 

• "Claimant is totally disabled" 

• "Claimant is temporarily totally disabled" 

• "Claimant unable to do any activity" 

• "Claimant cannot work" 

• "Claimant off work until MM/DD/YYYY" 

These types of general preclusion statements do not explain how or why the claimed 

impairment limits the claimant from performing his/her occupation. Statements made without 

clarification or specific comment to restrictions and limitations may trigger additional questions 

and it is appropriate to seek further clarification from the treatment provider making the vague 

11 
statements. 

Co-Morbid or Co-Existing Conditions 

Co-morbid or co-existing conditions can impact the overall functional capacity of an individual 

and should be evaluated for their combined effect on the claimant. 

Claim Managers should seek further clarification from treatment providers when they identify 

additional conditions or symptoms for which the claimant is or has been treated -or has 

reported -whether or not the claimant or provider is asserting Disability based on these 

conditions. 

Appropriate Care 

Standard language in our group disability contracts require a claimant "be under the 

Appropriate Care of a Physician," with Appropriate Care and Physician both further defined. As 

medical information is gathered and reviewed, consideration of this provision may include 

noting the following: 

• Specialty of the treating physician 

• Length of time treating with and/or frequency of treatment 

• Nature of the treatment being rendered or the treatment plan prescribed by the 

treating physician 

• Correlation of nature and level of treatment to nature and level of impairment 

assigned/claimed 

• Potential familial relationship between the claimant and treating physician 

• Third party statements (employment records, etc.) 

Reviewing Medical Information 

Once all requested information has been gathered, review by appropriate resources occurs. 

Above and beyond members of the Core Teams, this review can be accomplished either by 

internal or external medical resources. Reviews of medical information may result in claims 

discussions, written documentation of conclusions, and possibly even further 

recommendations or suggested next steps. When our opinion of a claimant's functionality 

differs with the treatment provider's conclusion of the claimant's functionality, limitations and 

abilities, contact with the treatment providers and/or utilization of external medical resources 

may be appropriate in an attempt to clarify functional discrepancies. 

Internal Medical Resources 

111 
Each FCO is staffed with medical resources who are available to review and provide analysis of 

medical information contained in a claim file. These medical resources may: 

• Offer advice on the completeness of medical records on file and recommend what, if 

any, additional information is needed to clarify a claimant's medical status 

• Assess medical information and assure it is pertinent to the claim 

• Contact treatment providers in an attempt to clarify information supplied 

• Assist in drafting narratives or questions for an I ME, FCE, Peer Review, or 

communications with treating physicians 

• Apply medical expertise relative to diagnosis, level of impairment, and expected 

recovery 

• Evaluate restrictions and limitations in relation to the reported disabling condition 

Releases "STD CM/NCM Medical Management Process" and "LTD CM/NCM Medical 

Management Process" provide additional detailed information on the workflow and referral 

processes for utilizing internal medical resources. The need for and use of internal medical 

resources may vary from claim to claim and will occur where the Claim Manager deems 

necessary, based on the facts of the file. 

External Medical Resources 

Various external medical resources are also available to review and provide analysis of medical 

information contained in a claim file. The need for and use of external medical resources may 

vary from claim to claim and will occur where the Claim Manager deems necessary, based on 

the facts of the file. Generally, these resources can be helpful in clarifying discrepancies in 

medical information or opinions and in identifying current functional status and level of 

impairment. This type of clarification may be particularly useful where, e.g., treatment records 

do not provide sufficient detail to determine the level of impairment, a treatment provider 

assigns restrictions and limitations that do not correlate with the clinical findings and 

observations documented in his/her treatment notes, there is an inconsistency of information 

provided by different treatment providers, etc. 

Where deemed necessary, an I ME, FCE, Peer Review, or other form of external review/exam 

can be utilized to either obtain additional information or clarify existing information. The 

release "Guidelines for Use of External Medical Resources" provides additional information on 

when the use of external resources should be considered. Releases "I ME Referral Process" and 

"FCE Referral Process" provide additional detailed information on the workflow and referral 

processes for utilizing external medical resources. 

IV 
Evaluating Medical Support of Disability 

Non-Disputed Medical Conclusions: 

Upon review of medical documentation, our internal medical resources may concur with the 

conclusions and functional capacity stated by the treating physician. What was reviewed, the 

agreed upon restrictions and limitations, expected duration, and any suggested ongoing followup for information will typically be documented in the claim file by the medical resource. 

Utilizing these conclusions, the Claim Manager will continue with the claim management 

process and evaluation of disability. 

In the event we obtained a Peer Review, IME, and/or FCE, and the treating physician agrees 

with conclusions stated in these reports, the Claim Manager will also continue with the claim 

management process and evaluation of disability. 

Disputed Medical Conclusions: 

Upon review of medical documentation, our internal medical resources may disagree with the 

conclusions and functional capacity stated by the treating physician. What was reviewed, 

restrictions and limitations the reviewer feels are supported, expected duration, and any 

suggested next steps will typically be documented in the claim file by the medical resource. 

When our opinion of claimant's functionality differs with the treatment provider's conclusion 

of the claimant's functionality, limitations and abilities, contact with the treatment providers 

may be appropriate in an attempt to clarify functional discrepancies. When these efforts do 

not resolve the questions of functional status and level and impairment, use of external 

resources may be appropriate in attempt to gain understanding of the claimant's functional 

capacity, or to provide additional documentation and rationale for the medical conclusions on 

which the evaluation of disability will be based. 

Following a review of medical documentation and discussion with the treatment provider, 

there may be instances when agreement on functional capacity cannot be reached. When this 

occurs, the internal and/or external medical resource provides a summary of available 

documentation and detailed rationale to support the medical conclusions on which the Claim 

Manager's evaluation of disability will be based. If a disagreement regarding the extent of the 

claimant's functional capacity exists, the medical resource may consider the following in this 

summary: 

• Cite findings from medical documentation in the claimant's own medical records or 

external examinations. (see "medical documentation" above for additional information 

v 
on what this may consist of). 

• Utilizing the cited findings and substantial evidence contained in the file, provide 

rationale for functional capacity. 

• Provide detailed explanation why the treating physician's conclusions exceed the 

findings or why these findings are inconsistent with the substantial evidence contained 

in the claim file. 

Evaluating Claims with Co-Morbid or Co-Existing Conditions 

Whole Person Analysis 

When evaluating a claim with co-morbid or co-existing conditions, Claim Managers should 

consider the impact of those conditions on the whole person and determine if the combined 

effect impacts the individual's ability to function in an occupational setting. Specifically, Claim 

Managers should review all data available including claimants' reports of symptoms as well as 

physical findings. 

All conditions that are relevant to the claimant's ability to function, including their combined 

effect on the whole person, should be considered. 

Claim Managers and Expert Resources should consider and afford appropriate weight to all 

conditions whether or not the claimant or the claimant's physician is asserting disability on the 

basis of the specific condition. 

When co-morbid or co-existing conditions exist, Claim Managers and Expert Resources share 

responsibility to ensure that all conditions are considered and afforded appropriate weight. In 

addition, when multiple resources are used, opinions should be coordinated to present a 

coherent view of the claimant's medical condition(s), capacity, and restrictions and limitations. 

Co-Existing vs. Co-Morbid Conditions 

• A claimant has co-existing conditions when s/he has multiple conditions, but all of the 

conditions may not impact his/her functionality. 

• A claimant has co-morbid conditions when s/he has multiple conditions that 

independently impact his/her functionality. 

In assessing and addressing each of these conditions within the context of their overall impact 

on the claimant's functionality, consideration should be given to the currency of each 

condition, e.g. conditions or symptoms the claimant experienced in the past may not impact 

VI 
current functionality. 

The following information should be evaluated and documented in the Medical Analysis 

Checklist as it pertains to the claimant's functional capacity: 

• Each condition should be identified along with any stated or identified restrictions and 

limitations 

• The combined effect of the diagnoses and impairments should be assessed for their 

impact on the whole person 

• Any additional information that explains the rationale of any conclusions reached. 

Summary 

Reviewing a claimant's medical status and confirming functional capacity are main components 

of determining disability. Medical information can be gathered from a variety of sources and 

our medical staff should be utilized, as needed, when reviewing the information on file, 

drawing medical conclusions, and proposing next steps. 

Medical conclusions assist a Claim Manager by providing a basis for functional capacity, 

expected resolution of the disabling condition, and feasibility of return to work. 

The claim evaluation and determination of disability are the responsibility of the Claim 

Manager. Claim determinations are based on conclusions drawn from multiple factors 

including medical, occupational, and financial documentation applied to the policy provisions 

at hand. 

Vll 
Exhibit D 

Guidelines for Use of External Medical Resources 

A. Treating Provider Related. When medical information in the claim file lacks 

clarity or sufficiency to assess the claimant's medical condition, functional status and level of 

impairment or where the claims handler has reason to question the opinions or information 

provided by the claimant's treating provider, the appropriate internal medical resource should 

contact the treating provider either by phone or by letter for clarification or additional 

information. If a telephone contact cannot be arranged, a letter outlining the question(s) and 

issues should be sent to the treating provider, which invites a reply either by phone or by letter. 

Following outreach to treating providers, if the claimant's condition, functional status and level 

of impairment are still unclear or if the claims handler disagrees with the opinions or information 

provided by the treating provider, the use of external medical resources, such as a Peer Review, 

an independent medical evaluation ("IME"), or a functional capacity evaluation ("FCE") should 

be considered under the following guidelines unless it is determined that the claimant's medical 

condition, functional status or level of impairment meets the policy's requirements. 

1. A Peer Review consists of an independent review and analysis of the claimant's 

medical records. A Peer Review should be sought whenever the question primarily concerns an 

issue of data interpretation, and therefore an examination of the claimant would not be useful to 

understand the reported condition causing impairment. 

2. An IME or FCE is an examination of the claimant by a healthcare professional 

and is typically conducted at the request of the company. These examinations can be used to 

supplement the claimant's medical record or provide greater detail as to the extent of the claimed 

impairment. An IME or FCE of the claimant should be considered when there are disputed or 

unclear medical conditions, functional status, or levels of impairment. These guidelines are the 

controlling document but Release IME Referral Process and FCE Referral Process may be 

consulted to provide additional detailed information on the workflow and referral processes for 

utilizing external medical resources. 

An IME or FCE of the claimant should be sought whenever there is lack of agreement and the 

opinion of the company's internal medical resource is the primary basis for denial or termination 

ofbenefits unless the following conditions are satisfied and well documented in the file: 

a) The Medical Director (a medical professional with the highest level credentials in the 

appropriate specialty relating to the reported condition regarding which there is 

disagreement or a lack of clarity) has reviewed the specific claim, focusing 

particularly on the area or areas of disagreement between the treating provider(s) and 

the reviewing internal medical resource; 

b) The Medical Director reviewing the file performs his or her own separate analysis of 

the issue or issues upon which there is disagreement, including any other information 

in the file deemed by the Medical Director to be relevant to the claim decision; and, 
c) The Medical Director reviewing the file concludes that the position ofthe internal 

medical resources involved in the claim file and in disagreement with the treating 

provider is correct, after having determined that the treating provider's opinion is not 

well supported by medically acceptable clinical or laboratory diagnostic techniques 

and is inconsistent with the other substantial evidence in the claim file. 

If the Medical Director reviewing the file is unable to reach the conclusions outlined in 

subparagraphs a) through c) above, then an IME/FCE should be performed. lfthere is a 

lack of clarity or a disagreement regarding more than one reported condition, then an 

IME/FCE should be performed unless Medical Directors with the appropriate specialty 

relating to each of these conditions are able to reach and document these conclusions. 

If the Medical Director agrees with the treating provider's opinion, there is agreement as 

to the current existence of a disabling condition and no IME/FCE is needed at the present 

time. 

B. Other Circumstances. An IME/FCE (or in circumstances relating to an issue of 

data interpretation in which case a Peer Review) should be sought whenever any of the following 

occurs unless the decision is made to pay/or continue to pay the claim: 

1. A prior IME/FCE found disabling limitations and the current impairment is based 

on the same limitations; 

2. An internal medical resource or other company resource, e.g., legal, compliance, 

or benefit specialist responsible for the claim, states that an IME/FCE is needed; 

3. There is a difference of opinion between two or more internal medical resources 

with respect to the existence of a disabling condition; or 

4. The claimant or the treating provider requests an IME/FCE, either directly or 

through the claimant's representative. 

C. Professional Criteria. A Peer Review, IME, or FCE must be obtained and 

conducted on the basis of objective, professional criteria: 

1. The company shall select individuals to conduct Peer Reviews, IMEs, and FCEs 

solely on the basis of objective, professional criteria, and without regard to results of previous 

reviews or examinations conducted by such individuals; and, 

2. Neither the company nor any of its officers or employees shall attempt to 

influence the impairment determinations of professionals conducting Peer Reviews, IMEs, and 

FCEs. 

11 
Exhibit E 

LINA Clinical, Vocational, and Medical Services 

Statement Regarding Professional Conduct 

Dear Medical Professional: 

UNA is committed to standards for the prompt, fair and reasonable evaluation and settlement of 

claims. As participants in the claims process we play an integral role in achieving these service 

standards: 

With a commitment to integrity, quality and superior service, we will: 

• Make appropriate decisions by providing a thorough, fair and objective evaluation of 

all claims. 

• Pay all valid claims in a timely manner with a high level of service. 

• Partner with our claimants in their efforts to return to work or to independent living. 

These goals cannot be fully realized without our full commitment to our professional ethical 

standards. Likewise, LINA's commitment is that these standards not be compromised in the 

course of our work activities on its behalf. Ultimately, however, professional ethical conduct is 

an individual responsibility. The measure of our success is how we conduct ourselves each day. 

Please review and retain the attached "LINA Clinical, Vocational, and Medical Resource 

Statement Regarding Professional Conduct." We are confident in your commitment to conduct 

yourselves in accordance with these high standards. 

Sincerely, 

[UNA Senior Officer] 
LINA Clinical, Vocational, and Medical Professionals' 

Statement Regarding Professional Conduct 

Clinical, vocational, and medical professionals will: 

).- Comply with all applicable laws, ethical codes, and standards of professional conduct. 

).- Communicate promptly and professionally. 

).- Discuss medical and/or vocational facts in an open and honest manner. 

).- Provide fair and reasonable evaluations considering all available medical and/or 

vocational evidence, both objective and subjective, both supporting impairment and 

supporting capacity. 

).- Consider all diagnoses and impairments, and their effect on the whole person, when 

evaluating medical and/or vocational data in a claim file. 

).- Work with or refer files to other appropriate medical personnel when specialization 

prevents one professional from considering all impairments and diagnoses in an 

evaluation of the whole person. 

).- Represent medical and/or vocational facts accurately. 

).- Provide reasonable, clear, and accurate explanations of professional opinions so that 

clear and full explanations of decisions based on those opinions are available to the 

claimant. 

).- A void redundant or unnecessary requests for information, e.g. duplicate information, 

data not reasonably required for adequate analysis, or data not material to the analysis of 

the claim. 

).- Report any significant barriers to achieving these objectives to [designate senior 

official]. 

I have read and understand the principles and guidelines above. I agree to abide by these 

principles in my work on behalfofLINA, and to consult with peers and managers ifl am unclear 

regarding my responsibilities under these principles or encounter barriers to abiding by them. In 

addition, prior to making each determination as to a claimant's impairment, for which I have 

been trained, I will certify that I have reviewed all medical, clinical, vocational and other 

evidence provided to me bearing upon impairment. 

Name Date 

ii 
Exhibit F 

Remediation of Certain Denied Claims 

The Companies will review certain claims made by residents of the Participating States 

and provide remediation as appropriate. The review will be in accordance with the enhanced 

claims procedures set forth in the Agreement and the criteria list below. 

All LTD claims made by residents of Participating States that were denied by the 

Companies on, or adversely terminated by the Companies as of, a date during the Remediation 

Period (defined below) shall be subject to review and remediation ifthe claim was denied or 

adversely terminated for reasons other than: a) application of other policy provisions that are not 

related to medical condition(s) (e.g. coverage eligibility, exclusions, and limitations); b) 

withdrawal of the claim; c) death ofthe claimant; d) not having satisfied the elimination period; 

d) maximum benefit had been paid; or, e) claimant returned to work or if the claimant initiated 

litigation and has not withdrawn such litigation (either independently or in favor of participation 

in the Remediation Program). Additionally, claims where a state insurance department has 

notified the Companies that it has accepted a fraud referral shall be excluded from the review and 

remediation. 

The Remediation Period ("Remediation Period") for the residents of all Participating 

States (except California) shall run from January 1, 2009 through December 31, 2010. The 

Remediation Period for residents of California shall run from January 1, 2008 through December 

31,2010. 

Claims will be reviewed to determine if application of the enhanced claim procedures set 

forth in paragraph B.1 of the Agreement would impact the delivery of benefits due. If there 

would be an impact, any additional benefits will be paid. If there would not be an impact, no 

additional action would be taken, and if it is unclear or more information is necessary and 

relevant to determine if there would be an impact, the Company will pursue that additional 

information. 

The Company is not required to analyze whether the procedures set forth in Exhibit B 

regarding SSDI awards would impact the delivery of benefits due where the Claimant's SSDI 

award date is more than one year prior to the Companies' claim determination date. 

If, during the course of reviewing a claim, factors which indicate additional benefits are 

due are discovered, a corrected payment will be made. 

When conducting this remediation, the Companies will adhere to all existing standards 

for request and response timing stated in: 

• the Contract under which the claimant is covered, 

• the Companies' existing compliance policies and procedures, and 
• ERISA Regulations, if applicable. 

Any remediation payment by the Companies will be subject to the following conditions: 

1. Claimants accepting remediation agree to forgo litigation and release the 

Companies from any further liability regarding denial or termination of benefits 

during the Remediation Period; and, 

2. Remediated claims shall not be the subject of any additional market conduct 

sanctions imposed by any of the Participating States. 

II