Our understanding is that "short-term disability insurance" covers any injury, ailment or other medical condition that causes you to miss an amount of time from work defined in your policy as "short-term". My wife was taken from work to the hospital by ambulance. Surgery was performed. Her personal doctor prescribed 6 weeks off from work. She had been treated a couple years earlier for similar heart palpitations. However, the issue was not over whether or not her insurance would cover the actual treatment. She purchased the short-term disability insurance as a supplemental policy to cover unforseen circumstances that caused her to miss work - and income. How is it that the insurance company can refuse to pay citing "pre-existing condition" under these curcumstances?
2007-12-17 06:03:53 · 9 answers · asked by Anonymous in Business & Finance ➔ Insurance
Your employer doesn't deny it - the insurance company does.
Your understanding of the insurance, isn't how the policy is written. When she applied for it, she needs to disclose any prior health issues.
If you disagree, and you "feel" that the policy DOES cover pre-existing conditions, photocopy the relevant pages, and write your state insurance department with a copy of the denial letter, and ask them to intervene.
2007-12-17 10:58:20 · answer #1 · answered by Anonymous 7 · 0⤊ 0⤋
Was your wife's previous treatment for heart palpitations disclosed in the application for short term disability insurance?
If she did disclose the condition and the policy was issued without a restriction she is entitled to the benefits. If she did not disclose the fact she had prior treatment then the company is entirely within its legal rights to refuse coverage.
2007-12-17 06:16:40 · answer #2 · answered by Tom Z 7 · 2⤊ 0⤋
You are correct in what the purpose of STD is but it is very common for a policy to also exclude coverage for pre-existing coverages. You need to read further in the policy. My guess is that it was very much within the scope of the policy. The reason the actual treatment was covered but not the STD is because they are two separate policies with different exclusions.
2007-12-17 06:14:26 · answer #3 · answered by mamatohaley+1 4 · 0⤊ 0⤋
The insurance company, not the employer, denied the claim. If there is a "pre-existing condition" exclusion in there, they have a right to deny. She had this medical condition before she obtained coverage.
2007-12-17 08:56:53 · answer #4 · answered by Sandy Sandals 7 · 0⤊ 0⤋
Get a lawyer.
Their is no 'pre-existing' with group coverage.
This is fairly common with insurance companies for group policies. Much like getting disability from the government, you pretty much expect getting a lawyer 90% of the time.
Best of luck, they need to pay up. $$$
[Let me guess, UHC?]
2007-12-18 18:22:45 · answer #5 · answered by Anonymous · 0⤊ 0⤋
You need to read the language of the policy you purchased. Odds are that it contains language excluding payment due to a pre-existing condition.
At this stage, there's nothing you can do about it. The time to have checked was when you bought the policy.
2007-12-17 07:29:01 · answer #6 · answered by acermill 7 · 0⤊ 0⤋
Was there a clause in the policy that denies pre-existing conditions? If not they must pay. One or two calls from your attorney will help them see the light.
2007-12-17 06:14:09 · answer #7 · answered by farmboy702003 5 · 0⤊ 0⤋
the employer cannot deny payments...it has to be the insurance co...and you can appeal and then contact the insurance boards
for your area...they are there to protect your interests
2007-12-17 06:14:43 · answer #8 · answered by Patti_Ja 5 · 0⤊ 0⤋
You need to hire legal consel.
2007-12-17 06:09:25 · answer #9 · answered by Anonymous · 1⤊ 0⤋