Reed Group Ltd

Thank you for allowing us to investigate this Customer Concern Our research into this concern revealed that the required documents to support the leave of absence request were not received, and therefore the claim was deniedThis customer was given the information to file a formal appeal, which was doneThe denial decision was upheld in the first and second level appeals process please consider this issue closed

[redacted] opened his leave outside of the employer’s timeframe for reporting a short term disability leaveWhile the leave was originally opened as short term disability, per the employer’s policy which states:“After the Employee has returned to work for work days or more are prohibited for opening a sick leave”The employee was eligible for the Family Medical Leave, protecting his job, but did provide the required supporting documentation.Please consider this case closed

We have reviewed [redacted] ' concern, and will contact the customer directly to discuss the outcome and decision. In summary, [redacted] had several duplicate/concurrent claims open simultaneously, and the required supporting documentation in now associated with the most recent and correct... claim. Please consider this issue resolved and closed.

Initial Business Response / [redacted] (1000, 9, 2015/07/27) */ Ms [redacted] is the employee of a former client of [redacted] GroupAs we do not manage her employer's benefits any longer, we were not in a position to be paying out her benefitsIt looks as though there was a lack of proper communication between the new benefits provider and Ms [redacted] In the interests of helping to remedy the situation quickly we have paid out the benefits in question to her and have cleared things up with her current providerWe now consider this matter closed

Thank you for giving us the opportunity to address this concernUpon review of this claim, *** ***'s case was approved based on the required documentation from her Health Care ProviderThis claim was closed as of November 2015. Please consider this issue closed

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

Complaint: ***
I am rejecting this response because:Dear ***:Thank you for your emailI am a current employee of *** ***The Reed Group is the third party leave administratorPer their instructions, I provided a " attending physician report" and the visit notes which indicated I was not to return to work until July 3rd As a suggestion, the doctor listed on his notes to also visit a psychiatristThe Reed Group has denied my claim based on this " psychiatrist" mentionThe absence was for a cardiac issue, and illustrated so on the forms provided to themIt is my contention that a referral to a psychiatrist does not indemnify The Reed Group from paying a claim or classifying my absence as a behavioral health is***. I have notified the Department of Labor and am considering filing a motion for injunctory relief at the federal levelThe standard of proof for such a motion is " undue hardship" and " irreparable harm"Both of these standards fall well below The Reed Group's policies for payment of short term disability claimsNo one returned my call, and I waited weeks for their denial letterThis is an unfortunate hidden secret that both my employer and the Reed Group are incented for not paying these claims. I have forms, documents, case numbers anything you may needMy number is ***Or you may respond to his email address. Sincerely yours,*** ***
***
*** ***

Dear Ms. ***Thank you for allowing us to address this your concern.Your initial request was made on 11/20, and on 11/you contacted us to make changes to your initial requestSupporting documentation was requiredUpon receipt of your documentation, clarification was needed from
your provider and your employer, which was received on 1/25/Your employer's disability plan requires specific documentation, which was received on 2/21/All eligible plans have now been approved appropriately, and paid in accordance with your employer's planSince you reside in California, you may contact the State Of California for information and eligibility on the state disability plan. Thank you, ReedGroup

Thank you for allowing us to respond to this concern.We have again reviewed the details surrounding Mr. [redacted] claim and ReedGroup's determination remains unchanged. Mr. [redacted] claim was administered in accordance with both his employer's disability plan and ReedGroup's operating guidelines.  Due to the confidential nature of this complaint, including personal health information, ReedGroup is unable to discuss the details further in a public forum. Mr. [redacted] has followed and exhausted  the procedures regarding appealing this claim decision. This matter is not open for further review, and ReedGroup considers this case closed.

Good Afternoon, [redacted], My name is [redacted], and I am [redacted] at Reed Group. Your inquiry to the Revdex.com was forwarded to me, and I would like to resolve this for you as quickly as possible. In order for us to investigate and...

resolve your concern, please provide me with name of your employer at the time the leave was requested. As soon as that information is received, we will begin investigating your concerns, and move towards a final response. If you have any questions, please feel free to contact me. I look forward to hearing from you. Sincerely, [redacted]

Complaint: [redacted]
I am rejecting this response because: This statement is demonstrably false and exemplary of the unethical practices of this company. I, along with my doctors, have provided every document requested and even offered to send in the DVD of my MRI, an offer which was declined. Documents listed as "reviewed" in Reed Group's own correspondence include but are not limited to:Podiatry Attending Physician's Statement dated 09/14/2017Physical Therapy Initial Evaluation and Plan of Care dated 09/27/2017Health Care Provider Form dated 10/10/2017Office Visit Notes dated 10/05/2017 and 10/18/2017Magnetic Resonance Imaging Results dated 10/10/2017This matter is far from closed.
Sincerely,
[redacted]

We have reviewed [redacted]' concern, and will contact the customer directly to discuss the outcome and decision. In summary, [redacted] had several duplicate/concurrent claims open simultaneously, and the required supporting documentation in now associated with the most recent and correct...

claim. Please consider this issue resolved and closed.

The wife called on 1/5/2016 and wanted to know the process, it looks like she was sent to voicemail. [redacted] talked to the employee on 1/6/2016 and he wanted a payment letter and she told him this was sent out. We do not have statements we send out monthly, we have the overpayment letter and when a...

payment plan is set up we send a payment plan letter. For further followup or to request a payment plan please have them call [redacted], Senior Benefit Calculation Specialist at [redacted].

[redacted]’s claim was received by Reed Group 5/11.  On 6/12 medical paperwork was received and reviewed by a Clinical Case Manager who  deemed it insufficient to meet the Employers Plan Provision of the definition of Disability.   The employee was sent the denial letter and also informed via phone of the claim denial. Based on the employee’s later request to speak with a manager, we attempted to reach the employee 3 times on 6/16.  All were unsuccessful.   On 6/28 documentation was received which instructed us to refer to previously sent paperwork, which was incomplete and did not include the appropriate information or approval signatures to make a determination on the claim.   On 6/28 the employee was informed telephonically of the need to have the paperwork completed and signed by the provider, to which the employee said he would follow up with the provider and request form completion.  The Claim Denial letter was also sent the next business day.    Thank you for including additional information this in our official response.

Upon review of [redacted]'s case file, it has been determined that the first set of paperwork received from her Certified health Care Provider was incomplete, and did not contain all of the required information to make a determination on her claim. Once complete paperwork was received, [redacted]'s...

claim was managed based on the information received from her Certified Health Provider. Please consider this issue resolved.

[redacted] opened his leave outside of the employer’s timeframe for reporting a short term disability leave. While the leave was originally opened as short term disability, per the employer’s policy which states:“After the Employee has returned to work for 2 work days or more are prohibited for...

opening a sick leave”. The employee was eligible for the Family Medical Leave, protecting his job, but did provide the required supporting documentation.Please consider this case closed.

Thank you for allowing us to respond to this concern. [redacted]'s initial submission of paperwork required clarification, in order for ReedGroup to manage his case. Once clarified paperwork was received by ReedGroup, [redacted] case was managed, and the claim was closed on October 1st, 2016.

[redacted] previously contacted ReedGroup to inquire about her case. We followed up with [redacted] today, and reviewed [redacted]’s case with her, including the recording the reported absences. We confirmed all valid reported absences with [redacted]. We reviewed the process that [redacted]...

[redacted] should follow to report absence, using her unique Case Identification number to ensure that all absences are accurately recorded. We provided [redacted] with her Case Identification number and  helped her to understand that the Case Identification number is never going to be duplicated and will always work when using the automated reporting functionality in our IVR.   Please consider this issue closed and resolved.

Thank you for allowing us to investigate this Customer Concern.  Our research into this concern revealed that the required documents to support the leave of absence request were not received, and therefore the claim was denied. This customer was given the information to file a formal appeal,...

which was done. The denial decision was upheld in the first and second level appeals process.  please consider this issue closed.

Initial Business Response /* (1000, 9, 2015/07/27) */
Ms. [redacted] is the employee of a former client of [redacted] Group. As we do not manage her employer's benefits any longer, we were not in a position to be paying out her benefits. It looks as though there was a lack of proper communication between the...

new benefits provider and Ms. [redacted]. In the interests of helping to remedy the situation quickly we have paid out the benefits in question to her and have cleared things up with her current provider. We now consider this matter closed.