Disability insurance problem

[jimsmith]

What is the name of your state? CA

I have disability insurance from "The Hartford".

Some time ago while being on disability I performed a contract work for company "XYZ" and reported this to the insurance company. The insurance company requested additional information regarding my work from "XYZ", but "XYZ" ignores all requests. It may be even out of business at this point.

The insurance company notified me about that and said that if they will not recieved requested information from "XYZ" during next month my claim will be closed.

What my options are? Please help. I appretiate any advise.

 

[CIAA]

jimsmith,

It is difficult to say without further information. However,your claim for benefits can not be denied if you in fact qualify based on the terms and provisions of the insurance contract. "Closing" a claim is the same as denying it and you may want to discuss the specifics of your situation with the California Dept. of Insurance, Claims and Complaints Division.

 

[jimsmith]

CIAA,

What further information would you like to get in order to give a more detailed advise?

 

[ellencee]

jimsmith
The Hartford has to give you the right to appeal any decision and they are required to notify you as to how you file an appeal, etc.

What they want to know at this point is whether or not you returned to gainful employment, earning enough to disqualify you as being disabled.

Send your case manager at The Hartford a certified letter stating that you have contacted XYZ company and list the dates and the methods of your contacting them and state you have asked XYZ, repeatedly asked, that the information be provided to The Hartford. Enclose copies of any paystubs or pay vouchers or other records of time and dates worked and for which you were paid and state that you have enclosed the information in an effort of good faith. Ask to not be held responsible for the lack of response to The Hartford by XYZ Company. State that you expect your claim to remain open and your benefits to continue to be received on X date of each month.

If your policy states how much you may earn while disabled, or how many hours, dates, months, etc. that you may earn while disabled, relate your enclosed information to the policy and point out that you have not exceeded the allowed amount of working while disabled.

If you have exceed the earnings allowed while disabled or the time spent at work while disabled, you may have to file a new claim for disability benefits; hopefully, your policy allows for you file a new claim if you are still disabled.

This site really does have a good section on disability insurance and may have the answers for which you are searching. Go to the home page; it's the fourth topic down in the right-hand column.

Best wishes,
EC

 

[CIAA]

jimsmith,

"elencee" is correct on all points and you should be able to show that you have attempted to obtain all information and that you will fully cooperate with Hartford. All you can do is tell them what the facts are and cooperate with them in providing whatever information and documents you have at your disposal. You are not required to do their investigation for them or to evaluate and handle your own claim.

In answer to your question, many things must be cosidered: Is this employer based coverage or an individual policy? Does it cover you if disabled from your "regular occupation" or "any occupation"? What is the definition of "Total disability"? Did you meet the definition of "Total Disability" while doing the contract work? Does the policy provide for "Residual" or "Partial Disability"? Did you satisfy these definitions while working contract work?

Finally, if individual coverage, you may or may not contractually have a right to appeal. Employer based coverage, ruled by ERISA requires that when receiving an "adverse benefit determination" ( closing a claim would meet this term) you are to receive notice and instructions on your right to appeal and any time deadline in which to do so.