Short-Term Disability Denied
Here’s the situation: I was denied short-term disability coverage by Amalgamated. They claimed my knee issue was a preexisting condition. While I did have a sprain back in 2022, I fully recovered and had an MRI that showed all my ligaments were intact.
Now, fast forward to August 2024—I ruptured my ACL. My surgeon replaced the torn ACL and a small lateral ligament with donor tissue and also cleaned up my meniscus.
Since December, I’ve been in constant communication with Amalgamated about my claim. My doctor provided a letter confirming that this is a separate injury. Amalgamated requested my medical records and MRI results for review. They assured me not to worry about paying the policy while they assessed my case. However, last week I received a cancellation notice for my policy 🙄.
In their written correspondence, they provided a specific number to call, but despite numerous attempts, I either couldn’t get through or encountered a busy signal. My insurance agent faced the same challenges when trying to reach them.
I’m wondering if I have any options or recourse. Financially, I’m in a tough spot, and I still have two months before I can return to work. What should I do next?
I’m really sorry to hear about your situation. It sounds incredibly frustrating and stressful, especially being left in the dark about your claim and facing financial strain. Here are some steps you could consider taking:
Document Everything: Keep detailed records of all your communications with Amalgamated, including dates, times, who you spoke with, and what was discussed. This documentation can be vital if you need to escalate the issue.
Review Your Policy: Carefully review the terms of your short-term disability policy. Understanding your rights and the definitions of preexisting conditions in your policy is crucial. Look for any clauses that may apply to your situation.
Contact Your HR Department: If you’re employed, reach out to your HR department for assistance. They might have experience dealing with the insurance company and could advocate on your behalf.
Seek Assistance from a Disability Attorney: It may be worth consulting a lawyer who specializes in disability claims. They can provide advice tailored to your situation and help you navigate the appeals process.
File a Formal Appeal: If you haven’t already, consider formally appealing the denial. This typically involves submitting additional documentation to support your claim, including your doctor’s letter and any other relevant medical records.
State Insurance Department: If you’re unable to get a satisfactory response from Amalgamated, consider filing a complaint with your state insurance department. They can provide guidance on your rights and investigate the issue.
Explore Other Financial Options: In the meantime, consider looking into other options for financial support, such as local charities, government assistance programs, or personal loans.
Stay Persistent: Since you’ve already put in significant effort to contact them, continue to be persistent but also be patient. These processes can often take time.
I hope you find a resolution soon and that your situation improves!