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Complaint 0 of 0 in "Claim for Benefits Denied / Delayed"
Insurance Carrier: Lewer Ins. of Illinois
My daughter is in Belleville, Ill. and had a problem with an insurance company due to a disability with her hands. She had carpel tunnel surgery on her hands and was off from work six weeks. She thought she had proper coverage for lost of work due such situation. She had taken out a policy through LEWER INS. to cover for life, health and disability. The agent came to her at her place of work. The company took the payments out of her paycheck. When my daughter called to see what they were going to do, they said nothing because she had to be in the hospital for 72 hours before they started to pay her. Both of her surgeries were performed as outpatient. But of course that's not what they told her at the time she was taking the policy out. But apparently D**** wasn't aware or they didn't care because the employee was picking up the tab.
Insurance Expert Answer:
"We are having trouble understanding this as it is not first hand from your daughter, and something is getting lost in the translation. Most disability policies have rather strict definitions as to what it takes to be regarded as "disabled" for purposes of the policy. The definitions tend to rely on the inability to do any kind of work in some cases, and the duration of the disability in other cases -- often with a waiting period. Here as she was out for 6 weeks, and had surgery before she was out, that would normally qualify. While standard policies do not require a 72 hour hospital stay as a condition precedent to being able to claim disability benefits, as this was optional coverage sold at her job, it may have been a strange bare bones and (relatively) cheap coverage: it almost sounds as if the the coverage she bought was designed to pay benefits in very limited circumstances -- sort of the insurance version of "unsafe at any speed." She should complain to her state's insurance department -- they typically have to approve all policy forms of coverage sold in the state."