Work comp investigation yields charges against Cigna

The Missouri Attorney General's Office has filed workers' compensation fraud charges against Cigna Insurance, one of its subsidiaries and its parent company, according to a news release from the Missouri Department of Labor and Industrial Relations.

The charges allege that Cigna, its subsidiary, Insurance Company of North America, and ACE USA, its parent company, did not provide required compensation to an Osage Beach undercover police officer who was injured in an automobile accident in 1989. Charges also were filed against a senior claims adjuster with Cigna.

Investigation

Charges were filed Oct. 31 in Camden County following a five-month investigation by the Missouri Division of Workers' Compensation Fraud and Non-compliance Unit.

This is the first time that an investigation by the unit has resulted in charges being filed against an insurance company for fraud, the release stated.

As a result of the automobile accident, the employee is a paraplegic, and he requires lifelong medical and nursing care, as well as expensive home and automobile modifications.

Although some of the money has been paid to the injured party, large amounts were paid more than two or three years late, and some compensation was still outstanding when the case was referred to the Attorney General's Office.

Ruling

The case was referred to the Fraud Unit after Cigna failed to comply with a ruling by the Missouri Court of Appeals, Southern District, affirming earlier decisions by an administrative law judge and the Labor and Industrial Relations Com-mission that the workers' compensation claim was valid and should be complied with.

In Missouri, workers' compensation fraud is a Class A misdemeanor for the first offense.

If found guilty, the charged parties would be subject to as long as one year in jail and a fine that is not to exceed $10,000 or double the value of the fraud, whichever is greater.

The case will be reviewed by a judge and an arraignment date will be set. All parties charged are innocent until proven guilty.

The case also has been referred to the Missouri Department of Insurance for further action.