payment on insurance perium refused

[bluedog40]

payment on insurance premium refused

What is the name of your state? ohio
My brother in law had a premium if not received by 12/22/2004 his benefit coverage would be terminated on 01/01/2005.He was diagnosed with terminal
brain turmors on 12/02/2004 only after collapsing at work.His short term memory was lost.His long term memory was very confused.I not knowing that his premium was due, it did not get paid.I discovered the premium needing paid on 01/06/2005 and immediately sent it in.They sent back the payment and terminated his coverage on 01/01/2005 They said they would reinstate him on 02/01/2005 because I paid the premium ahead with the payment I sent in on 01/06/2005.He had under gone medical treament through the month and died on 01/31/2005.There was a death beneift ailong with health insurance.
They have agreed to pay some of the medical bills because of an appeal letter
that was written and they said that the medical condition was prexisting.
They will not pay the death beneift.We do not know what to do next or even if we have a chance to win any judgement against them. please help!

 

[somarco]

The grace period (usually 30 days) is spelled out in the contract. In addition, it would appear the carrier gave sufficient notice to keep the plan in force. They also agreed to reinstate the policy despite the obvious change in health of the policy holder. (Whether it was obvious to the carrier at the time is not given in your post).

Reading your post again, it appears this is a health insurance policy, not a life policy. Is that correct? What kind of death benefit?

From the way your post is worded, it would appear that the death benefit is not payable since death occurred at a time when the policy was not in force.

Another issue in your post needs addressing. You say the carrier indicates this was a pre-existing condition, but yet they paid some of the bills. Pre-ex is spelled out in the contract. In most cases either the claim is paid or it is not under pre-ex clauses. The fact they paid SOME of the bills could indicate the door is open for further interpretation.

They have a right to deny claims incurred while the policy was lapsed. But to (appear) to pay some claims because of pre-ex, while denying others is suspicious.

Who is the carrier?

 

[bluedog40]

payment on insurance premium refused

The carrier is ohio carpenters health and welfare fund.The contract reads If a person was totally disabled at time of termination,certain benefits will continue for a limited period following the termination.We were not 30 days late on paying the premium.It was only 7 days.I appreciate you trying to help. Thank you so much!

 

[somarco]

Is this a supplemental plan?

Most plans through H&W are paid for via the hour bank and payroll deduction.