Denied short term disabililty

[frenchie]

I am a salaried employee and my shorrt term disability was denied because my administrator, claims that my doctor did not send the forms in before the deadline. I went into work and asked HR for the copy of the required medical leave form that they had on file from the doctor and the HR department faxed the required forms to them the same day which was before the deadline. I have been off for 23 weeks and the policy states that I can be off on short term disability for 26 weeks. I have received salary continuation at 100% pay for 22 weeks. On the 23rd week I did not receive a check. I have contacted my HR department but they keep putting me off. My doctor has filled out the forms on 4 different occassions 1 being a precertification form. I have worked for the company almost 6 years with no other attendance problems or any other problems. Is it right for them to deny my claim due to their claim that the doctor did not fax the forms in eventhough I faxed them in? I received a letter last week letting me know that eventhough I appealed the denial, the claim was still being denied. My question is-since the claim was denied should they have been paying me? Based on their policy salaried employees are not supposed to have a lapse in pay, but that did not seem to matter in my case this time. I have a copy of the fax receipt when the short term medical leave forms were faxed in and all the forms that the doctor has filled out. The doctor is very frustrated that he has been asked to fill out the same form over and over. My HR department keeps asking me if I am still under doctors care and why the claims administrator denied my claim. I have not broken any rules and I don't understand what is going on. I really need some help. I am out due to severe depression and stress and and this isn't helping me I am really in a bad way right now. Please help me know what I need to do. Should I hire a lawyer and if so what type of lawyer?

Frenchie

 

[cbg]

Well, let's first make sure that the blame is being put where it belongs. If your disability plan is fully insured (meaning that the disability carrier provides the money that you are sent weekly) then it's not your employer who is stopping your benefits but the carrier.

Where are the forms being sent? To your employer? To the insurance carrier?

 

[frenchie]

The disability carrier denied the claim, so I am not sure who provided the pay. The HR department told me at one time not to worry about the claim being denied because they had me on salary continuation because I was a salaried employee. The forms were sent to the disability carrier who is Cigna and the employer. I discussed the problem with my doctor and he suggested that I meet with my HR department in person to find out why my pay was stopped. I called the HR department today and tried to set up a meeting with them to discuss what steps I need to take to get my pay started again and find out what else they need from me and again I was told they would call me later.

 

[cbg]

I can't be certain without more information than you can provide, but it sounds to me as if the block is not with your employer, but with the carrier.

What I would suggest you do is as follows:

1.) Get on the phone with the carrier (HR can help you if you don't have the appropriate contact information

2.) Get them to tell you exactly what information is needed. Write it down.

3.) Get the name and address of the person at the carrier to whom it should be sent. I'm talking snail mail, not fax, e-mail or any other electronic transmission. Make sure you have it PERFECTLY. Read it back to them.

4.) Ideally, if possible, have a witness, preferably someone in your HR department, to the call.

5.) Even if the information they say they are missing has been sent several times before, do it one more time. Send it by some traceable form of snail mail; registered mail, Fedex, UPS, etc.

6.) Track it to ensure that it is delivered.

7.) Follow up by phone with the person in question. You now have proof that they have the information if you need to file a complaint with your state insurance commission.

 

[frenchie]

Thank you, I talk to the HR department today, you have been very helpful.