Contract Killers

After years of digging, Karen Ewers believes she's found that CIGNA stole benefits from her handicapped son

Ewers received a call from Gerrie Marks, the department's executive assistant for regulatory affairs, who told her the Department of Insurance had no legal authority to request Ewers' documents from CIGNA.

Department officials now tell New Times that the department could possibly have obtained the contracts from CIGNA if Ewers had filed a formal complaint.

Ewers says she did make a formal complaint, but she made it through the Attorney General's Office. On April 4, 2000, she says she was told by Shelby Cuevas of the Attorney General's Office to write her a complaint detailing the concerns.

Karen Ewers, former president of the Arizona March of Dimes, has spent the last 14 years struggling to give her son, Ryan, the physical and speech therapy he needs.
Karen Ewers, former president of the Arizona March of Dimes, has spent the last 14 years struggling to give her son, Ryan, the physical and speech therapy he needs.

Details

For the complete timeline of events click here

Cuevas later told Ewers she would need to seek private legal counsel because no one had time to look at her letter, Ewers says.

So Ewers hired insurance attorney Rick Berry.

At the same time, Ewers pulled together all her documents and research to try to understand what was happening to her. In particular, she began cross-referencing her own letters and schedules of benefits received from CIGNA since 1985 with the Department of Insurance's logs of insurance company filings.

With an auditor's precision, she pieced together the puzzle. And even without the last piece, ISAC 92-001, she was convinced she could see the picture clearly.


Arizona Revised Statutes state that no changes can be made to a policy without approval from the director of the Department of Insurance.

According to the Department of Insurance control logs, the benefit schedule mailed to Ewers by CIGNA in 1985 was developed by them to be used as medically underwritten insurance polices, not conversion policies like the one Ewers had.

The Department of Insurance approved that policy October 17, 1986. Ewers' policy went into effect January 1, 1987.

According to Department of Insurance files, CIGNA did not file this schedule as an amendment to Ewers' conversion policy until March 4, 1988. It was approved April 7, 1988, nearly 16 months after the policy changes had been activated.

Another change to her policy appears to have been filed four months late by CIGNA.

When asked by New Times if "CIGNA Healthcare of Arizona ever enacted a reduction in insurance benefits . . . before having approval for those policy changes from the Arizona Department of Insurance," CIGNA attorneys responded that it is the company's "standard business practice to file its plan service agreements for review and approval by the Arizona Department of Insurance prior to use. For this reason, CIGNA Healthcare would have obtained Arizona Department of Insurance approval for form ISAC 92-001 and other individual conversion plan and HMO service agreements before they were implemented."

New Times' question remained unanswered.

Interestingly, both of the late filings Ewers discovered were detailed on one of the control logs that was missing from the Department on May 20, 1999. The log later appeared after Ewers requested the logs through the Attorney General's Office.

Ryan Ewers began receiving speech therapy services from CIGNA in May 1988 that continued until the end of 1989. The benefits, then, could not have been removed in those two 1988 amendments.

The two early 1988 amendments are the only ones recorded for Ewers' policy before 1991, the year conversion policies could no longer be changed.

Which leads Ewers to believe the contract ISAC 92-001, which was approved after the state law changed, says one of two things:

That the therapy benefits still existed. (Remember, she says she never received the schedule of benefits. CIGNA says she would have.)

Or, the therapy benefits don't exist. If this is true, it would appear that those benefits were removed without proper approval.

Either way, she says, her family and every other family stuck in this death spiral conversion policy should be paid for years of therapy that CIGNA should have covered.


Ewers' attorney Rick Berry, who is chairman of the state bar's insurance committee, filed a complaint in Superior Court last summer seeking copies of the Ewerses' contracts.

The motions to dismiss and other barriers erected by CIGNA in the case have been masterpieces of obfuscation.

CIGNA said the complaint wasn't specific enough. It argued the case had to be heard at the federal level. It argued the Ewerses' 1996 request for documents wasn't specific enough. It argued it doesn't need to turn over documents to someone who has left CIGNA coverage.

A judge dismissed the first complaint, saying he didn't have jurisdiction to order the contracts turned over.

Berry filed a second complaint, this time seeking damages and repayment of unpaid benefits.

"This case arises out of Plaintiff's legitimate belief that CIGNA shortchanged insurance benefits of thousands of handicapped children in Arizona, including Ryan Ewers," Berry wrote.

The complaint hinted at a class-action suit.

"It seems that no matter what Plaintiffs do," Berry wrote, "CIGNA will not turn over something as simple as an insurance contract that it is, by law, required to maintain and produce. It must be that the insurance contract is so damaging that CIGNA will do whatever is necessary to avoid producing it."

CIGNA countered that any lawsuit regarding conversion policies should be handled under federal insurance statutes, collectively known as ERISA.

Those laws are considered by proponents of a federal patient bill of rights to be some of the most anti-consumer legislation in America. Under those laws, for instance, the Ewerses would be unable to receive any punitive damages.

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