Matrix Absence Management

Thank you for bringing this matter to our attention and we would like to acknowledge that we do take these complaints very seriously.  With regard to the specific experience of Ms. [redacted], we feel that we have been very forthcoming with information to allow Mr. [redacted] to have a solid...

understanding of her requirements as part of receiving monies under her disability policy.  In this particular case we have approved a Short-Term Disability claim for Ms. [redacted] and on 01/23/2014 we mailed her an approval letter which clearly informed her that her claim was approved from 01/23/2014 to 03/20/2014.  The letter also clearly outlined:"In regards to future benefits, we require additional documentation to support ongoing disability. Please submit medical records and fully complete the enclosed supplementary statement. Once we have received and reviewed the documentation requested, a decision as to whether or not you are entitled to additional benefits will be made in a timely fashion. While we will take reasonable steps to try to obtain this documentation on your behalf, ultimately you are responsible for providing proof to us of your ongoing disability."Additional medical information was received and as a result, Matrix extended these disability payments for the period of 03/21/14-04/07/2014.  An extension letter was mailed to Ms. [redacted] on 03/18/2014 which clearly outlined as well as the fact that additional payments would not be issued without additional medical information.  The letter outlined:"In regards to future benefits, we require additional documentation to support ongoing disability. Please submit medical records and fully complete the enclosed supplementary statement. Once we have received and reviewed the documentation requested, a decision as to whether or not you are entitled to additional benefits will be made in a timely fashion. While we will take reasonable steps to try to obtain this documentation on your behalf, ultimately you are responsible for providing proof to us of your ongoing disability."Additional medical information has been received and at this time the claim has been approved through 05/01/2014.  Please note that to receive benefits beyond 05/01/2014 Ms. [redacted] will again have to provide additional medical information.  If this medical information is not received or sufficient to support benefits beyond 05/01/2014, there may be delays in the processing of her claim payments.  We did speak with Ms. [redacted] and she is concerned about the fact that her checks have not arrived to her in a timely manner. Please note that we show checks were issued on:  02/6/14, 2/13/14, 2/20/14, 2/27/14, 3/6/14, 3/13/14, 3/20/14, 3/21/14, 3/28/14, and 4/2/14.  Any delays in the processing of these checks were due to the fact that additional medical information was not received to make a timely decision on her claim.  Ms. [redacted] also cited that it was her expectation that her checks would come to her on a weekly basis, regardless of when or if additional medical information was received.  Please note that it is a requirement of her disability policy that she is medically disabled in order to receive benefits under the terms of her policy and that her benefits are not guaranteed without proper medical documentation to support her time off work.  We do regret Ms. [redacted] being dissatisfied with her experience to date and we will attempt continue to partner with her to make sure that her experience is as pleasant as it can be when dealing with Matrix Absence Management.Sincerely, [redacted] Matrix Absence Management

There is nothing positive to say about my two claims I've had to open with this company, they have been rude, uncompassionate, told untruths to my family, and forced us to wait more than a month to being receiving payments after having lost a child at 23 weeks pregnant. This was the worst experience of my life outside of that. Now that I am pregnant again, they've denied my claim again, saying that they faxed the doctor info and the doctor didn't fax it back...but I had them send me the confirmation so I KNOW they did. I am just fed up with them altogether, I don't understand how they are in the business of helping people who are disable and this is how they treat them, its sad and VERY discouraging.

On September 15, 2014 we responded to a Revdex.com complaint, however on October 10,

2014 we received a follow up request which indicated [redacted] was not satisfied

with resolution response to her initial complaint. [redacted] maintains that Matrix’

response which states we attempted to contact her on multiple occasions unsuccessfully

is untrue and that her claim was rejected.

 

The file documentation shows that [redacted] called in a claim

on August 12, 2014 with a *ate of *isability of August 6, 2014 *ue to a motor

vehicle accident.  A medical request for information was sent to [redacted]’s physician [redacted] on August 13, 2014.  [redacted]'s medical certification was received

on August 19, 2014 from [redacted] and indicated that [redacted] would be released to return to work as of August 28, 2014. 

An email was sent to [redacted] on August 19, 2014 by the claims examiner indicating that Matrix had received the medical certification but

it was insufficient and we needed additional medical documentation to support her claim for disability.  At that time we also sent a request to [redacted]’s physician [redacted] requesting medical

records containing treatment and treatment plan notes.

 

In follow up, the examiner emailed [redacted] on August 25, 2014 and informed her that a medical request was sent to [redacted] on August

19, 2014 but we had not received a response from her physician.  On August 27, 2014 a second request was sent to [redacted] as well as an email to [redacted] informing her of the second request

that was sent to her physician [redacted] for medical records. 

On September 2, 2014 we received a phone call from [redacted] indicating that she was returning to work on September 2, 2014.  We sent her an email in response, confirming we

received her voicemail regarding her return to work and we also informed her that we were still waiting for records from her physician.

On September 5, 2015, [redacted] provided the medical records that were requested and the file was sent to our medical staff to be reviewed.  The medical review concluded

that the claim was medically supported from August 6, 2014 through August 29, 2014, the *ate [redacted] stated she could return to work.

The policy of [redacted]'s employer states: 

?WEEKLY INCOME BENEFIT

DAY BENEFITS BEGIN:  Benefits, for one period of disability, will be paid as follows:

INJURY AND SICKNESS:  We will pay benefits from the greater of: (1) the thirty-first consecutive day of disability; or (2) the day immediately following

exhaustion of the Insured’s EIB (Extended Illness Bank) hours available on the date disability occurs.

We sent an email to [redacted] on September 10, 2014 indicating that the medical review had been completed.  We advised her that since she had not been

out of work for more than 30 *ays, per the policy provision above, no benefits would be payable and her claim would be *enied.  We finalized the

determination on September 15, 2014 and mailed [redacted] denial letter on September 25, 2014.

While there was a delay in sending out the denial letter, we provided [redacted] with our determination via email on September 10, 2014.

I have found this company to be extremely unhelpful during my disability claims. Both times I have been out for back problems they improperly request documents to slow progress on my claims. Even now with my claim being accepted I have yet to receive any checks while out of work. The first time I filed checks mysteriously were lost in the mail or dated for much later than they claimed. This time I have been supposedly two checks in the mail and strangely neither have arrived. Even standard mail does not take this long. When I call my representative they are not helpful and give me the runaround. I honestly don't understand how a company like this can stay in business.

April 1, 2016[redacted]Revdex.comPhoenix, ArizonaRE: Complaint ID#[redacted] ("Complaint") Dear Ms. [redacted]Phoenix, Arizona 85029 4940Phone:...

###-###-####Fax: ###-###-#### This letter  shall serve as a response on behalf of Matrix  Absence Management, Inc. ("Matrix")to the above-referenced Complaint filed by [redacted].Matrix  is the third-party administrator for the short-term and long-term  disability benefits plans offered  to employees of Medstar  Health, Inc. This means that Matrix  is charged with handling requests  for  benefits  under  those  plans, including  ensuring  that  employee/claimants submit required  medical and other support for their initial, and continued, eligibility for benefits.Ms. [redacted]  was an employee  of Medstar  and according to  our records, received  payments under those plans from  2012 until January 21, 2016, when she was notified  by Matrix  that  she no longer  met the  eligibility  criteria  for continued, benefits  under  the terms  of the  Medstar plan.Because Matrix  takes great care to safeguard the information with  which we are entrusted, we are unable to provide  a detailed explanation of the medical information supporting our decision and are unwilling to disclose such information in a public forum,like the Revdex.com website. However, please know  that  Ms. [redacted]  has been provided with  information in the  January 21, 2016 letter  advising her of her right to appeal, and the method to do so, should she disagree with the decision to discontinue benefits.We trust that this information resolves this Complaint as to Matrix.

I am not happy with this company or how it has handled my claim from the beginning. Their letter of denial was complete of inconsistencies, and they even contradicted themselves. This company has a reputation for being sued for denying benefits to claimants on Incorrect information. 
They also made a "threat" to disclose their review to SSD which was also in review, trying to scare me. I was physically examined by a physician assigned by SSD and my benefits will continue indefinitely with periodic reviews. 
Matrix however, used a "consultant" with no expertise in my area of concern, and he made a decision based on information provided by Matrix. His comments were completely irrelevant to my case, so either he overlooked the pertinent necessary information, or Matrix neglected to provide him the necessary paperwork. He never interviewed me, never examined me, and formed his own opinion. This "consultant" is also known for being sued for finding in favor of the company and denying claimants their benefits.
Once I file my appeal, I expect a quick response in favor of continuing my benefits, and if not I will be suing them in court. I'm sick and shouldn't have to be going through this difficult time fighting for my rights. I want to be working but am not in any state to do so right now. I also want to prevent this from happening to other claimants in their time of need as Matrix has been sued over 57 times in the last 10 years and lost because they run a sham company, have no morals, high turnovers, and former employees even complain what a horrible company to work for.

I have filed for short term disability at end of sept 2016, it is now mid November-I have made repeated calls to MATRIX with no call backs-they have lied and said they have been calling me consistently with no answer-but on the two occasions they called and I was immediately available I CALLED them right back -yet they don't document this,they are constantly saying they don't hav e enough documentation from my doctors-I see a doctor once a week who has been sending records-yet they claim they haven't received these-my work place changed absent management companies on nov 1st but since initial claim started with Matrix the new company will not handle my claim saying Martix must handle this since it was initiated with them- I am so frustrated I could scream-poor customer service- dishonesty on their part- they claim they are trying to help me but at this point all I want is a yes or no to my short term disability claim

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this...

complaint resolved.

Regards,

In response to the Revdex.com Complaint#[redacted], I asked Matrix staff to prepare a summary of the actions taken to *ate, pasted below, having redacted claimant names.  In all regards, it appears we processed this claim in a timely manner, and with the interests of both the claimant and her...

employer being appropriately addressed.

[redacted]’s claim was filed on August 12, 2014.  We received a medical certification from her physician

on August 15, 2014 at which time the claim was forwarded to our medical *epartment to review.

 

This review was completed on August 18, 2014.  

Based on this review and the facts of the claim, we *etermined that [redacted]'s restrictions would prevent

her from working for the period from August 5, 2014 to August 14, 2014.

However, the policy under which [redacted] is insured indicates that she would have to be out of work and *isabled per

the contract for 30 *ays before Short Term *isability payments are to begin.

Since the above stated period is for less than 30 *ays, [redacted]’s examiner requested additional medical

information on August 19, 2014 to see if there was more medical information that may support a longer *uration.

We received an invoice from [redacted]’s physician on August 22, 2014 requesting an amount of $15.00 be paid as

pre-payment for the additional records requested.

This invoice was paid.  We received the records on September 5, 2014.

Therefore, [redacted]’s physician has been corresponding with us.  There *oes not appear to be

any evidence of non-receipt of records.  In the instances where [redacted] called and we had not yet received a responset this was communicated to

her.  However, her *octor responded to us initially, and then again once the pre-payment was received for records.

Currently, [redacted]’s claim is being reviewed for a final *etermination regarding her claim.  Once this

determination has been made, it will be communicated to [redacted]irectly.

Review: I went on short term disability and was approved from July [redacted] to Aug. [redacted]. After 4 weeks, I tried to return to work and wasn't able to perform like I needed. Matrix then canceled my short term agreement, after they said that I was approved. They are now refusing to pay what money is due to me. I keep sending documentation. They change what they need and ask for more documentation...over and over.. I would like the money owed to me. They are rude, hard to deal with and unprofessional. Plus they are in violation with my HEPA rights. They don't need to see my notes from my doctor, as they keep asking. If I don't not receive my money. I will sue for HEPA violations and money due.Desired Settlement: I want money due to me for my short term disability. I am a disabled veteran and should get some kind of respect and service.