Dying of Diabetes

[Kallen]

What is the name of your state? Kansas

My husband is extremely ill with diabetes. Two years ago, he had a stroke, and his company was bought by Allianz Insurance Group. When he returned to work, he was offered new benefits from Allianz including 3 times his annual earnings in group life insurance benefits. His salary and commissions were $111,000 per year. He is now completely disabled and receiving disability benefits from the company. However, the company is only offering him 64,000 in group life benefits, because they said when he returned to work, he was only working part time, thus they are basing his benefits on One half of his salary only. (21,000 per year times 3) The policy clearly states that the benefits are to be paid on the previous 12 months commissions which should be around 330,000 in benefits. It took us over a year to get his disability benefits, but they finally paid. He receives 5500 per month (60% of his previous earnings) We do not know what to do.

 

[CIAA]

Kallen,

It is a good thing that you are working on this now, and we hope your husband's condition will will improve.

You should talk to the employer HR department and find out who you should write to for a "disputed benefit determination". Write them and explain your position and ask for a response and explanation in writing.

This is going to be an ERISA plan, regulated and enforced by the U.S. Dept of Labor. As such you can also request in writing a copy of the Summary Plan Description (SPD) from the administrator ( this may be the insurance co., employer or a third party administrator and is required to be named in the SPD/Policy).

If their is still a disagreement, you should be able to appeal in which case you should find an attorney or insurance consultant.

If your husband has not applied for and been approved for Social Security Disability he should do so now.

Good luck and hope this helps

 

[Kallen]

The HR department has turned this over to the company attorney who has informed us that we should be "happy" we got the disability, and leave the life situation alone. They won't even talk to us anymore. We are supposed to be happy that Steve has had both legs amputated, and is in complete kidney failure?
The ironic thing is that he is an employee of a Life Insurance Company!
Do we go through ERISA to appeal? We can't afford an attorney.
He is receiving Social Security benefits - this was much easier to collect than his priviate disability benefits.
Kathy

 

[CIAA]

Kallen,

The decision maker in this matter should be the Plan Benefits Administrator, named in your Policy/Plan documents, also usually found in the employee manual. You should send them a certified letter explaining the situation and asking for a written explanation of their basis for the calculations of the amount of life insurance in force. It's imperative that you get every thing in writing including a copy of the plan documents if you do not already have them.

With the plan document and written explanation of how they calculate the benefit you should be able to get someone to help you determine if the benefit amount is correct.

While the plan and any appeal is governed by ERISA rules and regulations the appeal and your inquiries should be made thru the Plan Administrator who has a fiduciary duty to comply with the rules and regulations.