CLAIM REJECTED - GOT THE LETTER TODAY - PLEASE HELP!
The insurance company (that underwrites my former employer's STD group policy) rejected my claim for STD because of: (1) late filing of claim; and (2) lack of medical information to support claim.
(1) I never knew I had any rights to file a claim after my termination. The times I asked my ex-employer about claiming STD and/or LTD, it was explained to me that I was ineligible for them.
When I was able to get copies of the STD and LTD policies from my previous employer, HR had highlighted in the STD policy: "The Elimination Period is the amount of time you must be disabled before benefits start." and "Your coverage under the plan will end if . . . (y)our employment stops for any reason . . ." and "The deadline for filing a short term disability claim is 31 days after the end of the elimination period . . ."
Not highlighted, but relevant: "If, through no fault of your own, you are not able to meet the deadline for filing a claim, your claim will still be accepted if you file as soon as possible. Unless you are legally incapacitated, late claims will not be covered if they are filed more than one year after the deadline." (I filed my claim just before the 6-month mark.)
I had orthopedic surgery 23 days after becoming disabled (22 days after I was terminated) - I was released by my surgeon 7-1/2 weeks later. This interfered with my ability to file a disability claim. (My disability claim concerns an autoimmune condition, however - the orthopedic problem was just temporary.)
(2) My rheumatologist's office had not provided copies of my records (the fax from the insurance company was not received, then the doctor's copy service comes in only once a week and it takes them a week to make the copies).
Also, would it matter if I had my PCP do the paperwork? I have known her much longer, she understands my condition better than the rheumatologist, and is more supportive of my disability claim.
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I have 180 days to file a "request for review" which, of course, I intend to do.
Any advice for me? Do I need to hire a professional? Where would I find one?
Thanks for your help.