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Short term disability problems


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Does anyone have any experience with short term disability insurance not paying? Dh has been off work for 6 weeks now with a mysterious illness...he has been under a GPs care and now seeing specialist who is figuring it out...but Prudential is giving us grief....delaying the claim and 'reviewing it' and a claims adjuster just told me that 'benefits are not guaranteed.'

 

We are down to our last dollars and NEED this insurance until he gets back to work...Not sure what else to do.

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Is the insurance through an employer? If so, I recommend contacting the human resources dept. They should be helping coordinate the disability insurance.

 

If it is individually purchased insurance, I'd just keep pushing the insurance company. Call daily. If it is denied, appeal. If it is denied again, consider seeking legal advice.

 

Insurance companies like to delay payment as long as they can so keep hounding them.

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Is the insurance through an employer? If so, I recommend contacting the human resources dept. They should be helping coordinate the disability insurance.

 

If it is individually purchased insurance, I'd just keep pushing the insurance company. Call daily. If it is denied, appeal. If it is denied again, consider seeking legal advice.

 

Insurance companies like to delay payment as long as they can so keep hounding them.

 

It is through his employer. He is going to call them tomorrow. I am just beyond frustrated.

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I wanted to add that even when short term disability is processed without delay, it can take several weeks to get the first check. I wish you luck. :grouphug:

 

They will do direct deposit so that will help speed it up....and if we had confirmation it was coming I could relax a bit even if I had to borrow some money in the meantime.

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What size of employer?

 

Some policies are very "picky" about what they will pay for and what they deny. If it drags out a long time or is unfairly denied calling your state's Insurance Commissioner could be helpful. If you don't have one, you likely have someone charged with oversight, perhaps the Secretary of State's office.

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Very large engineering firm. Is that good or bad. :confused:

 

Hopefully calling his HR will help....if not that is a good idea going further up the chain. It is ridiculous at this point. Part of it is the incompetence of the GPs office...they took forever getting paperwork turned in...but now it is the insurance company.

 

What size of employer?

 

Some policies are very "picky" about what they will pay for and what they deny. If it drags out a long time or is unfairly denied calling your state's Insurance Commissioner could be helpful. If you don't have one, you likely have someone charged with oversight, perhaps the Secretary of State's office.

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We've been through it multiple times. Keep on it and find out who ultimately makes the decisions and when they do that.

 

There was one person who collected all of the paperwork and then a committee met to approve/disapprove. So we were calling the "collector" trying to get the package ready for the committee, and then we had to call for the decision and to see if the approval paperwork actually was completed.

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Very large engineering firm. Is that good or bad. :confused:

 

Hopefully calling his HR will help....if not that is a good idea going further up the chain. It is ridiculous at this point. Part of it is the incompetence of the GPs office...they took forever getting paperwork turned in...but now it is the insurance company.

 

Larger employers tend to have the most persistent and effective HR people to assist with pressing the contracted insurance company. They may be able to afford a larger HR department whereas in some small companies, there may be no HR department but instead a very busy accounting department or owner/operator. HR professionals know the ins and outs of the laws and the policies and may just know what to say, who to call or what to ask. The bigger the employer, the less likely the insurance company is to want to irk the HR and executives because they don't want the company to shop around.

Edited by kijipt
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We have aflac...and all we had to do was have the dr. fill out the forms with the issues and they processed them...BUT...he had a diagnosis. Im not sure if that is the difference? We had to submit every so many weeks but they always run very smoothly. Aflac and trustmark have been wonderful.

When we DO run into problems...We always start with HR! They are usually the only ones that can get the ball rolling. I guess they have different contacts in these insurance agencies.

Edited by mchel210
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We have aflac...and all we had to do was have the dr. fill out the forms with the issues and they processed them...BUT...he had a diagnosis. Im not sure if that is the difference? We had to submit every so many weeks but they always run very smoothly. Aflac and trustmark have been wonderful.

When we DO run into problems...We always start with HR! They are usually the only ones that can get the ball rolling. I guess they have different contacts in these insurance agencies.

 

Well, we do have a preliminary diagnosis just as of this Tuesday. And still I just got the call from Prudential saying 'the documentation does not support impairment. He appears to be self-limiting.' I almost started crying. I could very easily collapse into tears right now. I have to keep going though for dh.

 

They didn't bother asking the specialist for the records from Tuesday's visit. So that is what I am working on right now.

 

What a nightmare.

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Well, the nurse from the specialist's office read me the file notes that will be sent to Prudential. They sound much more comprehensive than the GP's notes so I am hopeful that the new info will be enough to get it approved.

 

Dh also called his HR department and they are getting involved.

 

This is just so ridiculous that at the time you are the most sick you have to deal with this kind of red tape.

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Just got a call from another case worker at Prudential. She seemed slightly more helpful. She is waiting on the additional records from the specialist before they deny the claim---in hopes that the new info will be enough to approve it. If it gets denied we have to begin an appeals process and that will just take that much longer.

 

The maddening thing is that Prudential won't accept email documentation...has to be faxed...and when anything is faxed to them it has to go into their mainframe in order to be processed into the individual's claim. That process takes 24-48 hours. So several times the very inept GPs office would fax something and then 48 hours later we would find out only the cover page went through or some such.

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