Question
Can I resubmit my case if my 6 month clause expired?
I was recently cleared for “full duty” labor, after an ACL surgery, back in January. Weeks prior, due to a down turn in the economy, my company closed its doors. Since I did not have a position to return to I was given a 6 month clause on my case, in case of any reoccurring issues. At my one year check up, in February, I noted some ongoing discomfort. I had an MRI in May, and in June it was determined that I would have to have a 2nd arthroscopic surgery, and was documented as “URGENT”. Emails and phone calls to Sunlife reassured me that the clause ended on August 23rd, and i would be covered after the surgery took place. That day has come and past with no surgery date scheduled. I did attempt many phone calls to my surgeons office, and reminders to the hospital were sent. Finally I have received my surgery date, October 25th, 2 months past the clause end date. I have try’d to reach out to my previous case manger at sunlife, but have yet to get a reply. Even though the clause has expired am I still eligible to re submitted my case, since we knew two months prior that a surgery was needed?
Answer
Steven, I am assuming you are referring to the Recurrent Disability provision of your policy. These provisions are usually pretty strict as to the 6 month timeframe. I would certainly suggest you file the claim though there could be issues not only with the Recurrent disability provision but also the fact that following your being cleared for work in January you were out of work not because of a disability but because your employer closed its doors.
