ltd denied to employer error

[marh55]

What is the name of your state (only U.S. law)? pa, I was receiving ltd from
fortdearborn and then they realized they were not our employer insurance
company, Assurant was. Well I never received any policy info from Assurant
company, our employer never notified us of the change, I also paid my own
premium out of my paycheck, Well Assurant denied my claim saying their policy required a 72 hour hospital stay. I have agorophopbia so being in the hospital was out of the question. Since I never recieved a policy from
assurant would I have a claim to appeal or should I get a lawyer. And anyways hospitals don't keep anyone in there for 72 hours anymore. my employer was sending the premiums to assurant and did not give us any information regarding assurants policies. Fortdearborn will want a reimbursement if Assurant approves the appeal. Thanks for your help.What is the name of your state (only U.S. law)?

[moburkes]

Originally Posted by marh55

What is the name of your state (only U.S. law)? pa, I was receiving ltd from
fortdearborn and then they realized they were not our employer insurance
company, Assurant was. Well I never received any policy info from Assurant
company, our employer never notified us of the change, I also paid my own
premium out of my paycheck, Well Assurant denied my claim saying their policy required a 72 hour hospital stay. I have agorophopbia so being in the hospital was out of the question. Since I never recieved a policy from
assurant would I have a claim to appeal or should I get a lawyer. And anyways hospitals don't keep anyone in there for 72 hours anymore. my employer was sending the premiums to assurant and did not give us any information regarding assurants policies. Fortdearborn will want a reimbursement if Assurant approves the appeal. Thanks for your help.What is the name of your state (only U.S. law)?

I don't see that you have a reason to get a lawyer. When they changed plans, the rules of the new plan are what you go by. Regardless of why you didn't stay in the hospital, if their rule is 72 hours, you can't change that.

I think you're referring to STD, not LTD.

[cbg]

Suppose you had known about the change in plan. What do you think would have happened differently?

You would still have been subject to the 72 hour requirement, which would not have been met. So you still would not have received any benefits.

You weren't thinking, were you, that the old plan would still be required to pay because you didn't get notified? Because that's not the case.

[moburkes]

Originally Posted by cbg

Suppose you had known about the change in plan. What do you think would have happened differently?

You would still have been subject to the 72 hour requirement, which would not have been met. So you still would not have received any benefits.

You weren't thinking, were you, that the old plan would still be required to pay because you didn't get notified? Because that's not the case.

Hey, lady. I suspect that your thoughts are exactly right. OP doesn't want to reimburse the new insurance company (I wouldn't either, if I truly had no idea that I wouldn't qualify).

[marh55]

Originally Posted by moburkes

Hey, lady. I suspect that your thoughts are exactly right. OP doesn't want to reimburse the new insurance company (I wouldn't either, if I truly had no idea that I wouldn't qualify).

I was received std from fort dearborn for six months, then transferred to
ltd. I have been off work since jan 2008. What I am saying isn't someone
responsible to have let us know and give us policy information for the new
company. the change occured in 2003. Fort dearborn did not of the change either. They have been very nice and do not reimbused unless I win the claim from assurant which looks doubtful. Thanks.

[moburkes]

Originally Posted by marh55

I was received std from fort dearborn for six months, then transferred to
ltd. I have been off work since jan 2008. What I am saying isn't someone
responsible to have let us know and give us policy information for the new
company. the change occured in 2003. Fort dearborn did not of the change either. They have been very nice and do not reimbused unless I win the claim from assurant which looks doubtful. Thanks.

Yes, they should have notified you. Had your STD deductions changed? It is unlikely, not impossible, but unlikely, that they changed insurance companies and the premium did not change. It is also unlikely that you signed up during open enrollment every year for the last 5 years and the new insurance company wasn't listed on the paperwork. How did the old insurance company not know that they hadn't received premium payments in 5 years?

[marh55]

Originally Posted by moburkes

Yes, they should have notified you. Had your STD deductions changed? It is unlikely, not impossible, but unlikely, that they changed insurance companies and the premium did not change. It is also unlikely that you signed up during open enrollment every year for the last 5 years and the new insurance company wasn't listed on the paperwork. How did the old insurance company not know that they hadn't received premium payments in 5 years?

I think the std was still from fort dearborn and ltd was one that changed. The claim adjuster noticed the change after 2 months of payment. Our HR
person said she wasn't notified from the top office. I was just wondering
if there was anything I could do. It just doesn't seem fair. Thanks for all
the advice.

[moburkes]

Originally Posted by marh55

I think the std was still from fort dearborn and ltd was one that changed. The claim adjuster noticed the change after 2 months of payment. Our HR
person said she wasn't notified from the top office. I was just wondering
if there was anything I could do. It just doesn't seem fair. Thanks for all
the advice.

I meant LTD, so thanks for the correction. I was just trying to understand how the HR rep or you could remember if the notification came 5 YEARS ago. However, I still believe that the name of the new insurance company and the premium deductions would have been different. I just don't see blaming this all on the company. At least you don't have to pay them back.

[marh55]

I'm feel justified blaming my employer, None of my co-workers recevied any polices changes either, I have one co-worker going through the same thing. No one in my office recieved any polices from assurant, just from fort dearborn as recent as last december 2007.

[moburkes]

Originally Posted by marh55

I'm feel justified blaming my employer, None of my co-workers recevied any polices changes either, I have one co-worker going through the same thing. No one in my office recieved any polices from assurant, just from fort dearborn as recent as last december 2007.

Now that's something different. Who sent you the certificate of insurance? The insurance company? Your employer? I'd follow up on that trail.

[cbg]

I'm still wondering what would have been different. If the new carrier will only pay if there is a 72 hour hospital stay and there would not have been a 72 hour hospital stay regardless, how is it that it was the employer's alleged failure to notify that caused the denial of benefits?

[moburkes]

Originally Posted by cbg

I'm still wondering what would have been different. If the new carrier will only pay if there is a 72 hour hospital stay and there would not have been a 72 hour hospital stay regardless, how is it that it was the employer's alleged failure to notify that caused the denial of benefits?

I'm not sure if that was directed at me. I agree with you 100%. It is just interesting that an insurance company which no longer insures any of the employees of the business since 2003 sends certs of insurance in 2007. But, I also believe that these people have to have been notified in several forms (open enrollment and pay check stubs) about the change.

[cbg]

It wasn't directed at you - it was a general observation.

[marh55]

I agree with all of you, but don't you think it is strange that Fort Dearborn
didn't even know, since they approved my claim and paid for 2 months before
they realized they were not our employers ltd company. I feel someone
made a mistake here and should be accountable. I denied being hospitalized
but whould have agreed if that was the critera of our policy, but no one
had the assurant policy, only the fort dearborn, It seem like our hr person
is trying to cover things up. but I don't want to cause trouble, since I
will be evently going back to work.

[moburkes]

Originally Posted by marh55

I agree with all of you, but don't you think it is strange that Fort Dearborn
didn't even know, since they approved my claim and paid for 2 months before
they realized they were not our employers ltd company. I feel someone
made a mistake here and should be accountable. I denied being hospitalized
but whould have agreed if that was the critera of our policy, but no one
had the assurant policy, only the fort dearborn, It seem like our hr person
is trying to cover things up. but I don't want to cause trouble, since I
will be evently going back to work.

But, you previously said that you weren't going to the hospital. So, I don't believe that anything would have changed, except you wouldn't have received the money that you did receive.