For the last eight years, it has been my full-time job to advocate for people to ensure they receive the insurance benefits to which they are entitled. Time and again, I have had many discouraged people ready to give up on the tedious and seemingly endless fight to securing coverage for lifesaving medications because of the runaround their insurance company has been giving them.
It is a game; to secure our business, the insurance company makes all these promises to help their policyholders when unexpected health and medical costs or tragedy interrupts their lives and security. Whether the coverage is through an employer’s group benefits plan, or privately purchased as a supplemental or stand-alone policy, policyholders faithfully pay their premiums and believe that their insurance company will have their back if needed. The sad reality is that the insurance company is not in the business of protecting the policyholders.
Claims for drug coverage, life insurance, disability insurance, critical illness, injury, travel – every single claim that an adjuster receives, is examined for reasons NOT to pay out, or at the very least, for reasons to delay paying out.
Every. Single. Claim.
I completely understand and appreciate that the insurance company takes steps to process only eligible claims; such diligence ensures that premiums and fraud are minimized, however to the insurance company, there is no line between diligence and robbery.
I know former underwriters who revealed that every single disability claim receives an automatic refusal, just to see what happens. The intent is for the claimant to accept the rejection without question, thereby reducing the number of dollars the insurance company pays out under otherwise qualified claims. One particular underwriter I know left her job because of this policy. When the underwriter’s job security and performance rating was based on the number of denied claims, it was clear that the insurance company was more invested in their bottom line than protecting the people who purchased their product. How many millions of dollars have insurance companies cheated their stakeholders out of by this internal policy, and how has that affected the lives of these qualified claimants? I have very recently had an insurance company reject a prescription drug authorization renewal, but refuse to state the reason because in the agent’s words, “that would be like giving out answers on a test”. This same medication was also previously covered by the same insurance company under the same policy, yet they arbitrarily refused the renewal – just ‘cuz. Yes, folks, accountability at it’s finest.
As I had detailed in my previous post, my son Ryan was brutally assaulted in a random attack on April 21st, 2017. Within minutes, his life changed forever only because some drunken low-life he had never met before was looking for someone – anyone to hurt. My son is now fighting with his insurance company because they refuse to pay out on his Short Term Disability until they have proof that he is not charged with any crime. Apparently being jumped from behind and having your head repeatedly stomped on until you were no longer breathing can make an insurance company suspect criminal charges have been laid against the victim.
Ryan obtained a court printout of the case details. Included in this document was the case number, the name of those charged in the case, the name of the victim, details of the charges, and the date of the incident. It goes without saying that my son’s name appears only as a victim. My son provided this clear proof to his underwriter. For some reason she won’t specify, the underwriter was not satisfied with this court document. She wanted the investigating officer to provide the written confirmation, but the officer said internal policy would not allow it, thus refusing to advocate for the victim in his own case. The underwriter also refused to act proactively to obtain the information she needed. It took several calls from my son to the underwriter before she finally agreed to pick up the phone. The FOIP – the Freedom of Information and Privacy department eventually received a request for information from the underwriter, but they stated they could not process it for at least a week – again, no advocacy for the victim. I had to get on the phone to impress upon the person at FOIP exactly how much my son has had to endure as a result of being a victim of crime before they would even consider trying to make this a priority.
Ryan’s injuries are one thing; he has now become a victim of the insurance company and every organization he has encountered that supposedly exists for the purpose of helping victims. Keep in mind that among my son’s injuries is a brain injury, and along with that brain injury is a reduction in his ability to function, communicate, and process emotion. These limitations are delightful to the insurance company because it makes the abuse of their power so much easier. To protect her authority from being challenged by anyone attempting to advocate for him, the underwriter claims that she must mail a consent to my son for him to sign and send back to her before I am permitted to speak with her about my son’s file. Yes, by regular mail. Verbal consent on their routinely recorded calls is simply too quick, and so is faxing the document – how fortunate for the insurance company to avoid having to speak with someone who is acutely aware of the games they regularly play. It is interesting that I can call this same insurance company and get complete disclosure about my patients. Evidently, she is actively blocking me from advocating for my son’s rights to benefits and fair treatment.
I know that Ryan will eventually receive his disability benefits to which he is entitled. However, the hidden cost of obtaining these benefits is to his health and well-being. I also know that the insurance company will utilize their standard bag of tricks to continue their efforts to make him give up, even after they have been forced to approve his claim.
At this point, Ryan has been without income for over a month. His bills and rent continue to go unpaid. He cannot return to work until his insurance company receives medical clearance (and he is looking at a long recovery due to his injuries), yet his insurance company won’t pay him the percentage of earnings he is entitled to. Several times my son wanted to give up – which is what the insurance company was hoping he would do. Ryan’s symptoms have worsened because the time and energy his doctor has directed him to spend in healing and recovery, he has had to expend in fighting for his rights to this fraction of his earnings. The remaining percentage he must do without – through no fault of his own unless he undergoes the long ordeal of a civil lawsuit against the negligent party associated with the assault, where the defence council will certainly make it their goal to delay awarding my son compensation for his losses.
The assault was only the beginning. This entire ordeal has affected every aspect of Ryan’s life; physically, emotionally, and financially. People keep telling him he is lucky to be alive and he does feel that gratitude, however that does not reduce his frustration and stress at having been placed in an ongoing battle for rights, he should not have to fight this hard to protect.
Ryan’s situation is not unique – I see it every day in my work and it both angers me and breaks my heart because I think about all the other people who have nobody to advocate for them – people cheated out of what is theirs. I can help my patients, and I can help my family, but who is helping the thousands of people out there like them who don’t know their rights or how to fight for them? Marginalization of under-represented people is a huge problem in society, and we see it everywhere. Two of the guiltiest groups are the legal system and insurance industry – both government regulated, which raises more suspicion as to who is looking out for the best interests of our population.
I would appreciate if readers would share this post. The solution to any problem lies in creating awareness, and I welcome stories from people who are also incurring the hidden cost of insurance; people who are going through or have been affected by the mistreatment of their insurance company.