posible loss of group life insurance coverage

[SnappingTurtle]

Does anyone have experience with loss of group life insurance obtained from an employer?

I have been on long term disability for 3 years, I think. Part of my disability benefit was premium waiver, which allowed me to keep my group life insurance without paying for premiums. I didn't even know such a benefit existed.

Recently, my premium waiver has been (incorrectly) terminated. I initiated an appeal but was told that I will have to convert my policy from group to individual policy while the appeal review is in process. If the appeal is successful, they will reverse the termination and reimburse me for premiums paid.

This conversion is what concerns me. It appears to be time sensitive and the process confusing. For sure, the rates are much higher under the conversion. They sent me a quote but for less than half my original coverage amount. I depleted my energy trying to get answers why the reduced amount on the phone and email, but I am getting the run-around, or tickets for "research" had to be put in first (time-wasters).

If you had to fight for and eventually won to have your premium waiver be reinstated, were you able to restore the full coverage amount or did you only get the reduced coverage?

 

[junkcrap50]

I'm sorry, I don't have any info that can help your situation.

It seems like they're wasting your time about going through an appeal process. It should be black and white in your policy. I would speak to your insurance agent and literally point to your policy contract where it says you have premium waiver. I might try threatening a lawsuit, because they violated the terms of your policy. You could also threaten to go to and/or talk to your local news station about doing one of their "citizen screwed/scammed & can't get justice" pieces. A disabled person from covid has to pay for their insurance's mistake and literally can't afford it due to no income might be a good enough tv piece for the station to be interested. Even just having email copies of corresponding with the reporter might be enough to scare the insurance company to correcting the error w/o going through appeals.

But I understand what a difficult position you're in. I'm sorry and I hope you find a solution.

I know of someone who was disabled from his/her job as the primary breadwinner and had to purchase health individual insurance for his/her self and family. They were audited by the IRS because of it, due to their healthcare spending going from a couple thousand/year to >$20,000. The audit turned out to not be a big deal since they had an explanation. Eventually to get cheaper insurance, formed an LLC or Trust or something with their family members as employees to be able to buy group insurance at much lower rates.

 

[SnappingTurtle]

@junkcrap50 thanks for commiserating. This is very stressful. I feel compelled to go through the appeal process because it might set a precedent/excuse through which my LTD (same insurer) benefit will be denied.

They insurer wouldn't even accept communications from my husband on my behalf, unless I have power of attorney document. That's another hoop I have to go through. It is frustrating and sad that insurers and their reps don't know (or worse, don't care) that even talking or emailing aggravates my symptoms. It takes me a whole afternoon to type up stuff, including this post.

My husband is helping review the thousands of pages in my claim file, which includes copies of my policy plan. This type of documentation in the past appeals for LTD had given us insight on what evidence had been accepted and ultimately let to overturning denials. It will be a long ehile to review. My head is aching after i tried to read 4 pages. So, I am leaving it to him.

Hopefully, my experience (successful or nit) will help someone in similar circumstances.

I will save lawyer and/or reporter options for later. It is also goid to know about llc formation and getting group insurance that way.

 

[maple]

You might consider asking your doctor to write declarations/letters. It will help your doctor if your husband can advise re what might be important, given the policy. It might also be worth considering that getting a lawyer involved now might ultimately cost less than engaging one later, since it might make the appeals process more efficient and hopefully more effective sooner. Just a thought.

I hope this is resolved soon.

 

[minimus]

As you probably know, it’s nearly impossible to obtain life insurance once you are disabled because of medical underwriting. So I would probably pay out of pocket to maintain the existing coverage through your employer’s group plan while you work to restore the premium waiver, get the original death benefit amount restored, and get a refund on premiums you pay.

I would not be too worried that this hassle is a prelude to the insurance company terminating your LTD benefits. It’s likely an administrative screw-up rather than a coordinated effort between the life insurance department and the disability insurance department at the insurer.

Your best bet is for you or your husband to contact someone in HR at your former employer and tell them what is going on. If it’s an administrative error by the insurance company, an HR employee should be able to troubleshoot for you. (The insurer is more likely to listen to a representative of your employer because the employer is paying the premiums for the group life insurance policy.)

I generally don’t like HR people because they work in the interests of employers, not employees, but I have gotten help on similar issues from HR people at my former employer in the past.

 

[SnappingTurtle]

@minimus , I sure hope you are correct that it is an administrative error and/or lack of coordination between the life and ltd departments.

I hadn't thought of how difficult it would be to get a new policy because underwriting will then be required. It is not hard to imagine they would reject ME/CFS patients. Thank you for pointing that out, @minimus .

UPDATe:
After several frustrating attempts of calling over several days, emailing and waiting on hold, we got the answers I sought:
1) the original coverage amounts can be restored if appeal is successful (as we correctly inferred), and
2) that there was nothing in my life insurance plan documentation that would reduce the coverage when converted.

Turns out the conversion unit (administered by a different company) made a typo in the coverage amount, leaving off a zero!

I am expecting a new quote and also asked to clarify the postmarked due date for the conversion application. It was ridiculous to read in the first quote a due date that was 2 weeks BEFORE the date of the letter.

Goodness, I am glad we questioned everything.

My former employer's HR was of no help. They farmed out their health benefits to another company, who kept directing me back to the also-3rd party conversion unit, who several reps claimed to know nothing or be unable to help me. I think what eventually convinced someone was a screenshot of the email sent to me by my claims analyst confirming the amounts I could convert.

Since ERISA regulations govern my group life insurance policy, I have to go through appeal process, before I will have a right to litigate. I hope it doesn't have to get that far.

I suppose, just like with LTD. I have to ensure all the evidence I need for possible litigation is included in my file. I expect new information cannot be introduced, once the appeal decision has been made. I guess I need to pull out my copy of "Know your Rights: a Handbook for Patients with Chronic Illness" by the late Jennifer Jaff, Esq. My crash will be harder to get out of, with all this reading.

Will update if I learn anything more. Thank you all for the support!

 

[SnappingTurtle]

My husband wrote an affidavit and helped write my appeal letter. We included my ME specialist's rebuttal. Thankfully, we were successful: the decision to terminate was overturned.

We are awaiting the return of premiums (which wass 10x more than normal) for the policy to which we had to convert,while waiting on the appeal.

I crashed after this.