Short-Term Disability Denied
To summarize my situation: I was denied short-term disability benefits by Amalgamated due to them claiming my knee issue was a preexisting condition. Although I sprained my knee in 2022, I had fully recovered and subsequent MRI results showed that all my ligaments were intact.
Fast forward to August 2024 when I ruptured my ACL. During surgery, my doctor not only replaced the ACL but also repaired a small lateral ligament and cleaned up my meniscus.
Since December, I’ve been in constant communication with Amalgamated about my claim. My doctor provided a letter clarifying that this is a new injury. Amalgamated requested my medical records and MRI, assuring me that I wouldn’t need to worry about paying my policy while they assessed my case. However, I received a cancellation notification for my policy last week.
In multiple correspondences, they provided a specific number to call for inquiries, but despite numerous attempts, I either faced constant busy signals or no answer at all. My insurance agent also tried the number but had no luck getting through.
I’m now in a difficult financial position, and with two months until I can return to work, I’m seeking advice. Do I have any options or recourse in this situation? What steps should I take next?
I’m really sorry to hear about the struggles you’re facing with your short-term disability claim. Navigating insurance processes can be incredibly frustrating, especially when it comes to medical issues. Here are some steps you might consider taking:
Review Your Policy: Take a close look at your short-term disability policy to understand the coverage details, specifically regarding preexisting conditions and the claims process. This will give you a clearer understanding of what Amalgamated can and cannot deny.
Document Everything: Keep a detailed record of all communications with Amalgamated, including dates, times, and the names of any representatives you spoke to. Document any difficulties you experience when trying to reach them.
Follow Up in Writing: If phone calls aren’t yielding results, send a formal letter or email detailing your situation, including your doctor’s supporting letter about the new injury. Request a written response regarding the status of your claim and the cancellation of your policy.
Contact a Consumer Advocate: If you’re still having trouble, consider reaching out to your state’s insurance commissioner or a consumer advocate. They can provide assistance or guidance on how to handle the situation and may help escalate your case.
Seek Legal Advice: If you feel your claim is being handled unfairly, it may be beneficial to consult with a lawyer who specializes in insurance claims or disability law. They can provide insight into your rights and potential options for recourse.
Explore Other Resources: In the meantime, investigate other forms of support you might be eligible for, such as state disability benefits or community resources that can help bridge the financial gap while you recover.
Stay Persistent: This process can be lengthy and challenging, but remaining persistent and proactive will help keep your case moving forward.
I hope you’re able to resolve this issue quickly and get the support you need. Good luck!