We are sorry to hear that [redacted] has a complaint concerning the Voluntary Disability Policy that she recently purchased from Amalgamated Life Insurance Company.Amalgamated Life Insurance Company is committed to providing a worksite/voluntary product that is affordable and offers...
protection during time away from work due to disability. During the enrollment process, we take steps to ensure that enrollees understand the process and timing for premium payments, the policy effective date, and the pre-existing condition exclusion provision.On January **, 2016, [redacted] applied for Disability Income Insurance and was provided a payroll authorization form (which she signed) indicating the date of her first weekly deduction would be on February **, 2016. This form also included the Pre-existing exclusion language from the disability policy as well as a signed statement indicating that she read and understood the pre-existing condition exclusion. In addition, she was given a Short Term Disability Insurance Weekly Rate sheet that included the Pre-existing condition exclusion language. During the enrollment process, our enrollment firm, Premier Worksite Benefits, advised the [redacted] that the effective date of the Policy would be April *, 2016. She paid weekly premiums during the month of March that applied towards the first month of coverage. On April *, 2016 she was sent the full Policy with an effective date of April *, 2016. Our records show that on May **, 2016, we received an incomplete disability claim form. On May **, 2016, we received the fully completed claim form for disability due to a medical procedure performed on April **, 2016. On the claim form, the complainant indicates receiving medical care or treatment beginning on January **, 2016 for the condition that caused her to become disabled.As outlined above, at the time of enrollment, [redacted] was provided with the following Pre-existing exclusion language, and also as defined in the Policy on page 5 and under exclusions on Policy page 9:"Pre-existing condition means an injury or sickness for which, during a 12 month period immediately preceding the Effective Date of this Policy, You have received a diagnosis or advice from a Physician and received treatment, incurred medical expenses or taken prescription drugs. The term Pre-Existing Condition shall also include any condition which is related to any such injury or Sickness. Pre-Existing Limitation Period means the period of time during which no benefits are payable for a Pre-Existing Condition. Pre-Existing condition limitation: We will not pay benefits for any condition or illness starting within 12 months of the effective date that is caused by, contributed to, or resulting from a pre-existing condition." Based on our review, we concluded that [redacted] had received treatment and advice prior to the effective date of the Policy, for the condition that caused her to become disabled on April **, 2016. This is the basis for the letter sent to her on May **, 2016, denying her claim for disability due to a Pre-existing condition. The letter included APPEAL RIGHTS, stating that if she disagrees with our decision, she may appeal the decision within 60 days of the denial. To date, we have not received an appeal from her. If she continues to disagree with this decision, she should submit a letter of appeal outlining the basis she feels the claim should not have been denied, and provide any additional information that is relevant to her claim.
We are sorry to hear that [redacted] has a complaint concerning the Voluntary Disability Policy that she recently purchased from Amalgamated Life Insurance Company.Amalgamated Life Insurance Company is committed to providing a worksite/voluntary product that is affordable and offers...
protection during time away from work due to disability. During the enrollment process, we take steps to ensure that enrollees understand the process and timing for premium payments, the policy effective date, and the pre-existing condition exclusion provision.On January **, 2016, [redacted] applied for Disability Income Insurance and was provided a payroll authorization form (which she signed) indicating the date of her first weekly deduction would be on February **, 2016. This form also included the Pre-existing exclusion language from the disability policy as well as a signed statement indicating that she read and understood the pre-existing condition exclusion. In addition, she was given a Short Term Disability Insurance Weekly Rate sheet that included the Pre-existing condition exclusion language. During the enrollment process, our enrollment firm, Premier Worksite Benefits, advised the [redacted] that the effective date of the Policy would be April *, 2016. She paid weekly premiums during the month of March that applied towards the first month of coverage. On April *, 2016 she was sent the full Policy with an effective date of April *, 2016. Our records show that on May **, 2016, we received an incomplete disability claim form. On May **, 2016, we received the fully completed claim form for disability due to a medical procedure performed on April **, 2016. On the claim form, the complainant indicates receiving medical care or treatment beginning on January **, 2016 for the condition that caused her to become disabled.As outlined above, at the time of enrollment, [redacted] was provided with the following Pre-existing exclusion language, and also as defined in the Policy on page 5 and under exclusions on Policy page 9:"Pre-existing condition means an injury or sickness for which, during a 12 month period immediately preceding the Effective Date of this Policy, You have received a diagnosis or advice from a Physician and received treatment, incurred medical expenses or taken prescription drugs. The term Pre-Existing Condition shall also include any condition which is related to any such injury or Sickness. Pre-Existing Limitation Period means the period of time during which no benefits are payable for a Pre-Existing Condition. Pre-Existing condition limitation: We will not pay benefits for any condition or illness starting within 12 months of the effective date that is caused by, contributed to, or resulting from a pre-existing condition." Based on our review, we concluded that [redacted] had received treatment and advice prior to the effective date of the Policy, for the condition that caused her to become disabled on April **, 2016. This is the basis for the letter sent to her on May **, 2016, denying her claim for disability due to a Pre-existing condition. The letter included APPEAL RIGHTS, stating that if she disagrees with our decision, she may appeal the decision within 60 days of the denial. To date, we have not received an appeal from her. If she continues to disagree with this decision, she should submit a letter of appeal outlining the basis she feels the claim should not have been denied, and provide any additional information that is relevant to her claim.