Sent: Monday, January 18, 2016 1:23 PM

To: EBSA, E-ORI - EBSA

Subject: RIN-1210-AB39 dept of labor

Re: RIN 1210-AB39

I am writing to comment on the Proposed Regulations issued by the Department of Labor, 

Employee Benefits Security Administration on November 18, 2015.

I currently receive disability benefits under an employer-sponsored disability plan governed by 

ERISA. In the process of securing benefits, I encountered numerous difficulties under the current 

claims-procedure regulations and recognize the urgent need to address these in the Proposed 

Regulations.

I have paid close to $50,000 in lawyers fees to fight for my benefits, fees that are unrefundable 

during the claims process, and are a great financial burden on a disabled person. The time, cost, 

and stress incurred in conducting my appeal was largely due to failure by the insurance provider 

(Cigna) to conduct a proper file review, and provide forthright and timely communication to me. 

They committed numerous procedural improprieties during the claims process. Numerous times 

they were in violation of the notice requirements under ERISA and this substantively affected the 

claims process. It is unconscionable that the disabled person pays for these failings in process 

that are clearly purposeful because of bias and the financial conflict of interest of the insurance 

company.

In my case, Cigna failed repeatedly to provide any meaningful analysis to support terminating 

benefits. Their medical reviewers interpreted tests selectively, ignoring the broader context of my 

medical record, and ignoring or mischaracterizing a weight of medical evidence from my 

specialists and doctors. They made recommendations based on these inaccurate test 

interpretations in context of a job that I did not perform, having failed to understand my 

occupation, instead going off generalizations of my job. They refused to provide requested 

documentation on any of the above decisions and analysis of my case, even after repeated 

requests.

Based on my experience documented above, the proposed tightening of the conflict-of-interest 

rules is welcome. It was clear that their medical examiners and claims administrators were 

working with the intention of denying my claim. The proposed amendments to the disclosure 

requirements should also prove helpful to disability claimants faced with a claim denial based on 

ill-defined reasons. The proposed “de novo” standard of review in cases where the plan has not 

followed the correct procedures should provide an effective incentive for disability carriers to 

comply with the relevant rules.

The Proposed Regulations give disability claimants like me more procedural rights in what is an 

unjustifiably uneven playing field at present. As I described in my personal experience, disabled 

claimants are faced with substantial procedural obstacles put in their way by disability carriers. 
This is particularly disturbing in light of the diminished capacity of most claimants to get 

through the cumbersome procedural hurdles placed on them by the disability carriers. 

For the above reasons, I strongly support adoption of the Proposed Regulations as soon as 

possible.