Question
Can LFG refuse to send me a copy of my policy? What do I do if they deny on basis of pre-existing condition?
I am really at a loss here and I don’t know how to handle this. I purchased Health Insurance through my employer which began on February 1st 2016. When I purchased the policy I was given the option of adding short term disability through Lincoln Financial. Since I suffer from depression in which I am currently taking medication and have had times where it became severe and I missed work, I thought this would be a wise addition. They immediately began deducting 15.00 per week from my paycheck for the coverage. In April of this year after refilling my prescription through a visit with a phychiatrist I called and emailed my HR manager and told him I never received my disability policy from Lincoln Financial. I have the email correspondence saved. I was told that they don’t actually issue a policy but he confirmed I had the coverage. I found that odd so I tracked down Lincoln’s phone number to ask them where my policy was and they also stated they don’t don’t send out policies. Is this legal? I alway get a policy when I buy Insurance. Just a few weeks back in June I had a mental breakdown. I immediately went back to my psychiatrist who thought some time off from work would be a good idea. I wasn’t going to do this until I remembered I had the short term disability policy which I purchased from work. The Doctor filled out his paperwork and my Employer complied filling out their portion of the paperwork and submitting it to Lincoln within 24 hours to Lincoln. I assumed all was good. Yesterday, I received a phone call from Lincoln telling me they would be sending me paperwork asking for additional info. I asked the rep several questions regarding my claim to make sure all was good. She told me they were looking for additional medical records and I asked why? She told me they do not cover pre existing conditions and they wanted to know when I began on medication for depression. To make a longer story short she told me my claim would not be eligible since I was on medication for depression before the policy started. Do I have any recourse? I am now sitting home more depressed then ever. How can both my employer and Lincoln deny me a copy of my policy when requested? I can’t just go back to work now that the short term disability was requested.
Answer
Frank, the duty to provide an employee benefit plan typically falls on your Employer, so they would be responsible for providing a copy of the company coverage. You can formally request it from your employer and when doing so indicate that you are making the request pursuant to Section 1332 of ERISA. Unfortunately, pre-existing condition limitations are very common in disability insurance products and are legally enforceable. That being said, it does not mean the application of the provision by Lincoln is necessarily correct. We would need to see a copy of the denial letter to assess what recourse you may have.
