The Disability Jerk Around

[somarco]

The acquiring company, lets say it is Guardian, doesn't really have their name on it... and they could give a damn that the Penn Mutl name is on it...

Spot on.

PM was never a big player. Seems like it was essentially a private label product reinsured by Unum (but could be wrong). Lot's of carriers operated that way.

Could it be that in Guardian's take over of this block of business, the records never made it over? They could be stalling in hopes you have copies that will actually provide them with the information they need?

Very possible. Happens quite a bit when a block is assumed.

More likely the plan has a lot of latitude in defining disability. They are using every bit of the contract to stall the claim.

That's a problem in dealing with a 2nd tier carrier.

 

[Crabcake Johnny]

Well, if major stroke resulting in no movement or speech isn't disabled I wonder what IS disabled

 

[moonlightandmargaritas]

Well, if major stroke resulting in no movement or speech isn't disabled I wonder what IS disabled

No doubt. This kind of BS is an outrage.

Whether the acquiring carrier (if there is one) has a complete file or not is immaterial. They're on the risk, like it or not.

You (and your sister-in-law) ought to start kickin' and screamin' and raisin' holy hell. File a complaint with the DOI, go to the media, whatever.

Sometimes (as my Mom used to say) you've got to fight fire with fire.

 

[somarco]

Strokes are odd things. Sometimes the damage is permanent, sometimes not.

Policies usually have language that refer to total AND PERMANENT disability.

What is the benefit waiting period?

How long has he been disabled?

Not defending the carrier. Just trying to figure out a way to address the denial.

Whose claim form did you use? Penn or Guardian?

 

[SportsNut]

Well, if major stroke resulting in no movement or speech isn't disabled I wonder what IS disabled

The def of "disabled" is what the insurance company says it is, until you can force them to change their opinion. Sad... but reality, apparently.

 

[moonlightandmargaritas]

Is this individual coverage, or some sort of group thing through the bar association, etc.?

 

[Crabcake Johnny]

Update: my brother received his first disability check for the full amount a few days ago.

 

[bill3173]

Update: my brother received his first disability check for the full amount a few days ago.

I would like to be the first to say Congratulations. Until someone has done what you have, it's difficult to empathize with that situation.

I've had to assist in filing claims for Cancer, Accident and health policies for people close to me, and it can be stressful dealing with people on the other end of the phone, when they don't care.

I had a lady client my first year in the biz that was diagnosed with invasive cancer 38 days after the policy was written. After hassling her and rejecting claims for 3 months, we got a lawyer involved. They paid her attorney fees, all of the money owed and a letter of apology.

It takes persistence and a cool head when dealing with these people.

Good job.

 

[disability Insurance Reso]

Best to get yourself a claims consultand who knows what goes on in the back room, attorneys may know law, but they don't necessarily understand how DI works.
If you need further assistance,drop me a line.
Best till then Larry (claims consultant- 800-551-6211)