Workers Comp Question

Dec 31, 2008

  1. indmedins
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    indmedins Guru

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    I got a lead today and she was declined or postponed (not sure, wasn't her agent) from Humana due to what seems to be due to the fact she filed a workers comp claim.

    About two years ago she was on a group plan at work and was having pain in her arm. As it turned out, the pain was stemming from a condition like carpal tunnel of the arm from working on the computer at work. She got treated and all her hospital claims were paid by her group plan, didn't need any meds. Time went on and she lost her group coverage, and was picked up on Humana. She was fully covered and later on got another job and was picked up with a new group plan. Somewhere around this time, she opened a workers comp claim on this condition as she thought it was a work related injury. Since the claim was started, workers comp has been fighting with her group insurer at the date of service.

    Now, she needed individual coverage again and was recently denied by Humana from what seems to be due to having opened a workers comp claim. It must be, because from the condition she was describing shouldn't be declinable. And, Humana was not the carrier at the date of service for her arm.

    What are the ramifications when someone selects "yes" to the workers comp question? Is she a permanent decline? Any incite on workers comp and health insurance here would be appreciated. I am going to do a prescreen for her at a few carriers Friday outlining this situation, but would like your guys input as I don't want to pre-screen if she is a lost cause. She is willing to drop the workers comp claim if she can then get heath coverage. Thanks in advance.
     
  2. Crabcake Johnny
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    Crabcake Johnny Guru

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    Two jobs and two worker's comp claims? Walk away.
     
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