Denied Short-Term Disability Coverage
To summarize my situation: I was denied short-term disability by Amalgamated due to a preexisting condition related to my knee. Although I sprained my knee in 2022, I fully recovered and had an MRI that confirmed all my ligaments were intact.
Fast forward to August 2024, when I tore my ACL. My surgeon performed a procedure to replace my ACL and a small lateral ligament with donor tissue, and also repaired my meniscus.
Since December, I’ve been in constant communication with Amalgamated regarding my claim. My doctor provided a letter stating that my current injury is distinct from the previous one. Amalgamated requested my medical records and MRI results, assuring me that I wouldn’t have to pay the policy premium while they were making a decision. However, last week I received notification that my policy has been canceled 🙄.
In several written communications, they provided a specific number to call for further assistance, but I’ve tried countless times without success—either the line is busy or there’s no answer. My insurance agent also attempted to reach them, but with no luck.
Do I have any options or recourse at this point? Financially, I’m in a tight spot, and I still have two months until I can return to work. What should my next steps be?
I’m really sorry to hear about the challenges you’re facing with your short-term disability claim. Here are some steps you might consider taking:
Review Your Policy: Carefully read through your short-term disability policy to understand the specifics about preexisting conditions, claim denial processes, and cancellation terms. This can provide clarity on your rights and options.
Contact Your Doctor: Since your doctor has already provided a letter stating that your current injury is separate from your previous condition, you might want to ask for further documentation or a more formal medical opinion to support your case.
Request a Formal Review: If you haven’t already, formally request a review of the denial from Amalgamated. Include any additional medical evidence that supports your claim and reiterate that the ACL injury is unrelated to your prior condition.
File an Appeal: If your initial claim is denied or if your policy is canceled, you usually have the right to appeal the decision. Make sure to follow the correct procedure for filing an appeal as stipulated in your policy documentation.
Document Everything: Keep a clear record of all communications with Amalgamated, including dates, times, and summaries of conversations. This documentation can be critical in supporting your case.
Seek Legal Help: If you continue to have difficulty getting a response or feel your claim is being mishandled, consider consulting with a lawyer who specializes in insurance claims or disability law. They may be able to provide advice or intervene on your behalf.
Contact State Insurance Department: If you still feel that your claim is being unjustly denied or mishandled, you might also consider reaching out to your state’s insurance department for assistance and guidance.
Explore Alternative Financial Support: In the meantime, look into any other resources or programs that may provide financial support while you’re off work. This could include temporary assistance programs or community resources.
I hope you’re able to resolve this situation soon and get the support you need!