• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Disability insurance

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

B

bluejay72

Guest
I have not worked since the end of November due to the discovery and treatment of a rare advanced cancer. I had enrolled in a long-term disability plan through my employer in 11/98. My cancer was discovered in 9/99. I worked until the end of 11/99, when I had to begin an aggressive course of a special type of radiation that required a trip across the country for 6 weeks. Being a young, strong woman, I didn't expect the treatment to disable me in the way it did, despite being warned by my doctors. I expected to recover from the treatment within weeks of my return, but the side effects came and went in waves that left me on the couch and in bed for usually 18 - 20 hours every day. I'm not as weak now, but I'm still fatigued and dealing with other side effects. I also have more surgery coming up, and close monitoring with my doctors every 3 months for several years since there is a high propensity for recurrence.

After being out of work for longer than expected, I asked my doctors if they thought I should try to collect on my disability plan. They said I definitely should. I have a Stage 4 cancer that is completely unpredictable. There's no way to test to see if it's gone, and there's no way to tell if it's back unless another large tumor forms and shows up on an MRI.

I applied for my benefits, provided the necessary documentation, and within a few weeks, I had a check. Then, when my second check didn't come when expected, I called and learned that my employer had submitted my claim to the wrong company. They had switched plans on January 1, 2000, and my qualifying 13 weeks began under the prior company's coverage. The new company forwarded all of my documentation to the prior company, but they wouldn't accept it. They required that I fill out all new forms and get all new forms filled out by my doctors. This was a pain, but I made sure it was done within days. I kept calling them weekly to follow up and make sure they had everything they needed, and I kept being told it was in process. From time to time I'd get a phone call or a letter requesting information that I had already submitted two or three times, but I always provided the information.

This week, I was told a decision would be made by Wednesday morning. When I didn't receive a call, I called and left a message. Later that day I had a call from them that they needed more information. They faxed some forms to me explaining that they needed to conduct a pre-existing condition investigation. As I said, I enrolled in this plan in 11/98 and was not diagnosed with cancer until 9/99. It was a shock to everyone, including the surgeon that removed the tumor.

I have two questions. First, doesn't a condition have to be diagnosed before an insurance company can call it pre-existing? Secondly, how long does a disability insurance company have to make a determination? (Is there a time limit in which they must decide?) As I said, I provided them with all the information they requested within days, and I made sure my doctors did the same. This all started in March. It's been nearly 3 months now. Fortunately, my family has been able to help with my expenses and support me all these months. I don't know what I would have done otherwise. It just seems there must be a law about how long a company can take to make a determination on a claim - whether it's in my favor or not. Any information/advice would be appreciated.
Thank you.
 


T

Tracey

Guest
A condition is preexisting if you knew about it, or should have known about it, or knew of symptoms that should have sent you to the doctor for tests that would have discovered the condition. I have no idea if it's unusual to go from healthy to stage 4 cancer in 10 months. However, the ins.co. appears to be dragging its feet by taking 3 months to process a disability claim. File a complaint of bad faith dealing with your state ins. board.

------------------
This is not legal advice and you are not my client. Double check everything with your own attorney and your state's laws.
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top