Prudential
I can’t understand why I am being penalized for their incompetence
I have been on STD disability since 11/17/2014, for MS. As of a week ago, I did not get paid and my STD benefits were suspended. I called to speak with the claim manager whom stated they suspended the coverage as they did receive any medical records. The problem with that is, my doctor only specializes in this disorder and understand how imperative it is to answer records request. I spoke with a nurse at my doctor’s office, and she informed me there were never any requests received on their end, which is why the records were not sent. Turns out they were sending requests to the office line and not the fax line. My application from November contained the correct information, including the correct fax number, and I signed the form they told me too in order for my records to be released. I can’t understand why I am being penalized for their incompetence, I’m the one whose sick. No claim managers called an told me of this problem until they suspended my benefits 4 months into the coverage. Now they’re telling me it may take up to a month to rectify the situation. I already missed one pay period and soon to be a second. I cannot find any logical explanation to how this is my fault. Also, the claims manager informed me my LTD will probably be denied due to the look back provision as I was not with my employer for a year. I was diagnosed originally on June 6th, and started my job June 30th. I did not start any treatment until the end of July, I was not under any routine care from a physician, and my condition did not worsen till November. The LTD did not get denied yet, and my STD doesn’t expire till 5/11/15. Is there anything that can be done about this situation? It is causing a terrible financial burden, and the stress of the situation as a whole is exacerbating my symptoms.
Reply
Jay, there does stand a likely chance that your STD will be reinstated based on the medical records. With respect to the LTD Policy, from the dates you provided it does appear that your claim would be subject to a pre-existing condition provision found in most ERISA based disability policies. If you have been covered under the policy for less than a year when you file a claim it will trigger a pre-existing condition evaluation. The typical language reads that the carrier will review the period 3-6 months prior to effective coverage (or employment) to determine if you were diagnosed, treated for or received medical attention due to the condition you are claiming disability for then the condition is deemed pre-existing and not covered.
