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#52798 11-21-2003 07:05 PM
Joined: Sep 2002
Posts: 642
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I am one of the fortunate ones who had private disability insurance when I was diagnosed. Although I hated making those payments, I did it for years and never missed a one. When I was first diagnosed, one of the companies sent an investigator who wanted
"to put a face with the name" to check me out. Fortunately I am a lawyer and had a former partner who specializes in insurance law who offered to help me for free, so I had the guy meet me at my lawyer's office and directed that all future communication be through my lawyer.

The company did pay, but I still did not appreciate a guy coming to investigate me...after all I had throat cancer, not carpal tunnel syndrome! Recently the other company ( I had policies with two companies ) sent its fraud investigator to check me out and "put a face with the name". I also had this fellow meet me at my lawyer's office.

Now company number one is sending a CPA to town to go over my tax returns, income statements and calendar in an effort to justify stopping payments. The irony is that I bought my policies back in the days when they allowed you to specify your " own occupation ", meaning if I cannot perform the main duties of my profession, they must pay. My occupation was specified as " trial lawyer." Our contention is that I still cannot try big, long, hard, jury trials, due to speech problems, fatigue, swallowing difficulties, etc.
The insurance companies want to ignore this approach and talk about how much money I am earning and how many hours I spend at the office.

Isn't it funny how the guy that sells you these policies is always a fine fellow, someone that you grew up with or whose kids go to school with yours. But when the catastrophe that you insured against arises and you make a claim, you encounter a whole different set of characters who are determined to pay you as little as possible, if anything at all.

Ah, insurance companies!

Danny G.


Stage IV Base of Tongue SCC
Diagnosed July 1, 2002, chemo and radiation treatments completed beginning of Sept/02.
#52799 11-22-2003 02:46 AM
Joined: Sep 2003
Posts: 153
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hi Danny,

Investigators checking you out hey? Well i like your approach of meeting at your lawyers place.

the disability insurance company that i deal with had a different appoach. I have a group policy thru a large professional society that deals with a major carrier. A written copy of the policy is here at home... the company rep tells me they want copies of not only mine but also my wife's tax returns... no where in the policy does it say they are entitled to that info... yet the company rep insists that its 'standard policy' and is listed in company admendments to the policy... i tell her that the policy requires them to send me a copy of admendments... naturally she refuses to send the documentation... so i sit on it and refused to supply that information... they paid anyway.

so i wonder, where are these 'insurance reps' coming from? and when is it time to complain to the state insurance review board?

cu,
larryb

#52800 11-22-2003 04:38 AM
Joined: Sep 2003
Posts: 139
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Dear Danny and Larry,

Well, good to know that I am not alone. We have private insurance as we retired early (by choice). Started this insurance policy in June and was diagnosed with SCC in July........figures. The company has not started to pay as they are trying to proved that I had a preexisting........They cannot prove this so now they are saying I didn't tell the truth on our phone interview. That's true. On the advice of our independent agent, I denied taking any meds. The reason for this was that I get all meds through VA and would not be costing the insurance company anything for them. The case is in committee now and I fear the results. Anybody have any ideas?
Judy U


Judy U
Stage I SCC floor of mouth, left radical neck dissection 8/03
#52801 11-25-2003 01:42 AM
Joined: Oct 2002
Posts: 546
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Danny,

Heather had disability insurance through her employer. They paid the short-term part (the first 6 months) with no problems. When it came time for the long-term part of it to start, the ins. co. said she had to apply for Social Security Disability benefits. If she didn't apply and the ins. co. determined she was eligible, they would stop paying. I always thought you carried private ins. so you wouldn't have to use government services. I'm still not sure how they justify that, but since Heather's employer paid the bulk of the premiums, we followed the rules and applied for the SS. Just doesn't make sense somehow.

Now, Heather's husband has applied for the mortgage insurance to be paid. I just can't believe the info the co. wants. They want to know all the doctors she has seen in the last 5 years. I guess they are looking for a reason to deny the claim, but 5 years?!? How can a visit to a family doc or ob-gyn 5 yrs ago have anything to do with a cancer diagnosis 13 months ago? I know there are a lot of people trying to scam ins. companies and they do have to have proper documentation, but that is a little ridiculous.

Larry,
Good for you for standing your ground. It is so easy to be cowed by these people. After all, most of us are taught to obey the rules and listen to authority. Unfortunately, these companies use that against us to get out of their legal obligations. It always comes down to the bottom line.....money. They don't seem to have any compunction as long as they can save a $.

Judy,
I am sorry I don't have any good advice for you. I did work as an ins. agent several years ago and I can tell you that lying on an application is not a wise thing to do. Your independent agent should never have given you that advice and I would definitely hold him accountable, but I just don't know if that will help you win your case or not. As far as the pre-existing condition goes, check the laws in your state. In Pa, ins. cos. are not allowed to use that anymore. They will try though, so consumers have to be on their toes and know the law. Otherwise they can get away with it anyway. Do you have a lawyer helping you? Good luck.

Rainbows & hugs, wink
Rosie


Was primary caregiver to my daughter Heather who had stage IV base of tongue SCC w/ primary recurrence. Original diagnosis August 21st, 2002. Primary recurrence March 18th, 2003. Died October 6th, 2003.
#52802 11-27-2003 05:10 AM
Joined: Sep 2002
Posts: 642
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Amazingly, the fraud investigator fellow recommended that I only send in reports to the insurance company every three months instead of monthly as I have done from the beginning. Small miracles!

Of course I am now gathering financial records for the CPA who is coming to town to audit my records...even though my lawyer believes that the records are irrelevant to our claim. Oh well, before it 's over we may have to play hardball with these guys. On the other hand if I am doing well enough to try cases like I used to, my claim will no longer be valid.

Rosie, it seemss like the insurance companies just want to make it so difficult to collect that you guys will give up.

Best of luck,
Danny G.


Stage IV Base of Tongue SCC
Diagnosed July 1, 2002, chemo and radiation treatments completed beginning of Sept/02.

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