Reliance Standard Life Insurance

June 2, Dear [redacted] ***:We are in receipt of your letter dated May 23, 2014, which was received in our Law Department on May 28, Your inquiry has been forwarded to my attention for a response.As part of her complaint, [redacted] recounts what she considers to be a difficult claim history with Reliance Standard (our)She cites the fact that her Long Term Disability (LTD) claim has been denied on two separate occasions and that she successfully appealed each timeShe states that she had undergone financial hardship due to our adverse determinations on her claim[redacted] continues towards her ultimate complaint for which she requests resolution; the overpayment that has occurred on her claimShe states, in part, I have now been approved for SSD and they have back paid meI am now getting letters from Reliance wanting me to refund them the money they have paidI think this is so wrong that they pray on the weekThis Insurance is something that I elected through my employer and money was taking out of my check for it.” [redacted] further states, I do not feel I need to pay back any money that they have given me for disabilityThis is why we pay premiums.” The desired settlement noted is, Stop Contacting MeThe group policy number under which [redacted] in insured states, in relevant part:BENEFIT AMOUNT: To figure the benefit amount payable:(1) multiply an Insureds Covered Monthly Earnings by the benefit percentages), as shown on the Schedule of Benefits page;(2) take the lesser of the amount:(a) of step (1) above; or(b) the Maximum Monthly Benefit, as shown on the Schedule of Benefits page, and (3) subtract Other Income Benefits, as shown below, from step (2) above.We will pay at least the Minimum Monthly Benefit, as shown on the Schedule of Benefits page.OTHER INCOME BENEFITS; Other Income Benefits are benefits resulting from the same Total Disability for which a Monthly Benefit is payable under this PolicyThese Other Income Benefits are:(1) disability income benefits an Insured is eligible to receive under any group insurance plans), -(2) disability income benefits an Insured is eligible to receive under any governmental retirement system, except benefits payable under a federal government employee pension benefit;(3) all permanent as well as temporary disability benefits, including any damages or settlement made in place of such benefits (whether or not liability is admitted) an Insured is eligible to receive under:(?) Workers' Compensation Laws;(b) occupational disease law;(c) any other laws of like intent as (a) or (b) above; and(d) any compulsory benefit law;(4) any of the following that the Insured is entitled to receive from you:(?) wages, excluding the amount allowable when engaged in Rehabilitative Employment; and(b) commissions or monies, including vested renewal commissions, but, excluding commissions or monies that the Insured earned prior to Total Disability which are paid after Total Disability has begun(5) that part of disability or Retirement Benefits paid for by you that an Insured is eligible to receive under a group retirement plan; and(6) disability or Retirement Benefits under the United States Social Security Act, the Canadian pension plans, federal or provincial plans, or any similar law for which:(?) an Insured is eligible to receive because of hisher Total Disability or eligibility for Retirement Benefits; and(b) an Insureds dependents are eligible to receive due to (a) above.Disability and early Retirement Benefits will be offset only if such benefits are elected bythe Insured or do not reduce the amount of hisher accrued Retirement Benefits then fundedRetirement Benefits under number (6) above will not apply to disabilities which begin after age for those Insureds already receiving Social Security Retirement Benefits while continuing to work beyond age 70.Benefits above will be estimated if the benefits:(1) have not been applied foror(2) have not been awarded; and(3) have been denied and the denial is being appealed.The Monthly Benefit will be reduced by the estimated amountIf benefits have been estimated the Monthly Benefit will be adjusted when we receive proof(1) of the amount awarded; or -(2) that benefits have been denied and the denial cannot be further appealed If we have underpaid the Monthly Benefit for any reason, we will make a lump sum paymentIf we have overpaid the Monthly Benefit for any reason, the overpayment must be repaid to usAt our option, we may reduce the Monthly Benefit or ask for a lump sum refundIf we reduce the Monthly Benefit, the Minimum Monthly Benefit, if any, as shown on the Schedule of Benefits page, would not applyAs the above policy provisions state, we are to subtract any disability or retirement benefits that an insured is eligible to receive under the United States Social Security Act from the LTD benefit amountIn our initial telephone interview on January 26, 2012, we discussed this provision with [redacted] and explained to her that her LTD benefit would be reduced by any amount that she is eligible to receive from the Social Security AdministrationWe further explained that the policy affords us the right to estimate the amount that she would be eligible to receive for Social Security Disability Income (SSDI) and to reduce her LTD benefit by this amountUpon the approval of her LTD claim, we sent [redacted] a letter dated March 23, reiterating that the policy allows us to reduce her LTD benefit payments by the amount of any estimated SSDI benefits for which she may be eligibleWe explained that if she wished to receive her full LTD benefit without this estimated reduction, she needed to provide us proof that she has applied for SSDI and a completed Reimbursement AgreementWe further explained that in the event that her request to waive the estimated offset is approved, an overpayment may result if she or her dependents are awarded benefits from the Social Security AdministrationWe continued to explain that in the event of a benefit overpayment, she would be required to reimburse us in full within days of her receipt of the notification by us [redacted] signed and dated the Reimbursement Agreement on April , (see attached copy)The Reimbursement Agreement is a formal request from [redacted] for Reliance Standard to waive any estimated SSDI offset and to pay the full LTD benefit with no reductionBy signing and dating the Reimbursement Agreement, [redacted] acknowledged the terms listed in the agreement, which includes a statement that she must reimburse us for the full amount which may be overpaid to her in the event that she is awarded SSDI benefits, including retroactive awards.On July 30, 2013, we contacted [redacted] by telephone and advised her that we were in need of an update on the status of her SSDI applicationShe stated that she spoke with her attorney three weeks prior and was told her appeal may be reviewed sometime in SeptemberWe requested that she contact her attorney and have them send us a letter indicating at what stage of the application process she was atOn July 31, 2013, we received a letter from her attorney revealing that the SSDI application was pendingOn April , 2014, [redacted] contacted us to advise that she was awarded SSDI benefits and would forward a copy of the award letter to usWe received the Notice of Award letter from the Social Security Administration on April 14, We sent a letter to [redacted] dated May , which explained that due to her entitlement to SSDI benefits that began on July 1, at the rate of 1,per month, her claim has been overpaid in the amount of 35,for the time period of June 3, to April 3, As explained above, the policy stipulates that we have the right to recover the overpayment that has occurred on [redacted] ***LTD claim [redacted] does have the right to file a formal appeal within days of his receipt of the May , letterIt should be noted that we did receive a formal appeal from [redacted] on May 16, The file has been sent to our Appeals Department for reviewWe will not take further action in collecting any debt that is owed us until our Appeals Department has completed their review of the fileOnce the review is complete, we will continue to request repayment of any debt that is owed usSincerely,

---------- Forwarded message ---------- From: [redacted] < [redacted] > Date: Fri, May 2, at 11:AM Subject: complaint ID # [redacted] To: [email protected] To whom it may concern: Please note that the company finally settled this matter with me on their own as of this morningThank you -- Best regards, [redacted] , Esq Phone: ###-###-#### Fax: ###-###-#### [redacted]

We are in receipt of your letter dated August 7, 2015, which was received in our office on August 12, Your inquiry has been forwarded to my attention for a response.In her complaint, Ms [redacted] states that she underwent surgery on June 6, She filed her claim on May 21, and has yet to receive a paymentShe states that her doctor’s office advised her that we repeatedly filed the incorrect papers to the wrong doctor’s office, with the incorrect doctor names for pulling her recordsShe was also informed that the papers that were submitted were not filled out in their entiretyMs [redacted] states that she returned to work early because she could not afford to be without pay any longerShe is concerned that her early return to work threatens her surgery and that she is jeopardy of losing her property because of nonpayment.The group policy under which Ms [redacted] in insured states, in relevant partPRE-EXISTING CONDITIONS: An Insured will be considered to have a Pre-existing Condition and will be subject to the Pre-existing Conditions Limitation if(1) the disability begins in the first twelve (12) months after the Insured's effective date; and(2) an Insured was diagnosed or treated by a legally qualified Physician with consultation, advice or Treatment occurring during the three (3) months immediately prior to the Insured's effective date of insuranceWeekly Income Benefits will not be paid for a disability: (1) caused by or (2) resulting from a Pre-existing Condition unless the Insured has been Actively at Workfor one (1) full day following the end of twelve (12) consecutive months from the Insured's effective date of insitrance.We received Ms [redacted] ’ claim on May 14, Upon our initial review of her claim, it became evident that we needed to conduct a pre-existing condition investigationMs [redacted] ’ claimed date of disability was April 22, and the effective date of her insurance was July 1, As her claimed date of disability is within the first months from her effective date of insurance, we need to determine if she was diagnosed or treated by a legally qualified physician with consultation, advise or treatment occurring during the time period of April 1, to July 1, (the three months immediately prior to her effective date of insurance), for a condition that caused or resulted in her disabilityIt should be noted that a pre-existing condition investigation is sometimes a lengthy processThere are a number of variables that could affect the amount of time that the review takes, including, but not limited to, the number of providers that treated the claimant during the three months prior to the insurance effective date, and the length of time that it takes for the providers to send the records to usThe following summary of the timeline of events will show that in the case of Ms [redacted] ’ claim, any delays in processing are due to the length of time that it has taken her treating physicians to provide the requested documentation to us.On May 19, 2015, we sent Ms [redacted] a letter explaining our need to conduct the pre-existing condition investigation, along with a form (Pre-Existing Condition Questionnaire) which asked her to provide the contact information for any physician, hospital, and/or pharmacy that would have treated her for any condition for the time period of April 1, to July 1, On the same date, we sent a request for all medical records from April 1, to present to DrW [redacted] D [redacted] , the physician who completed the disability claim formWe received the completed Pre-Existing Condition Questionnaire from Ms [redacted] on May 26, On May 27, 2015, we sent requests for records for April 1, to present to DrW [redacted] C [redacted] and DrAllen W [redacted] On June 4, 2015, as we had yet to receive a response from DrD [redacted] , we sent a second request to his officeOn June 8, 2015, we received a response from DrD [redacted] ’s office ( [redacted] ***) advising that the Reliance Standard Authorization for Use in Obtaining Information form that Ms [redacted] completed to release records to us was not acceptable to their office because the authorization was not datedThe claims Examiner, Courtney H***, called Ms [redacted] on that same date and advised her of the response from DrD [redacted] ’s officeMs [redacted] stated that she still had a copy of the authorization and would date it and return it to our officeWe received the dated authorization on June 9, and sent it to DrD [redacted] ’s officeOn June 11, 2015, we had still not received a response from DrC [redacted] or DrW [redacted] As such, we sent second requests to their officesOn June 17, 2015, we received a response from DrC [redacted] ’s office stating, “Dr W [redacted] C [redacted] has not seen this patient since 2014.” However, on the same date, we received an invoice from Healthport, the medical records copying service for DrC [redacted] ’s office, for pages of recordsWe sent payment to Healthport for the recordsOn June 18, 2015, MsH [redacted] called DrC [redacted] 's office and advised that we were in receipt of their response, but our request did in fact as for all records from April of to presentThe representative at DrC [redacted] ’s office asked us to send the request to them againQuite strangely, we received another response from DrC [redacted] ’s office on June 22, stating, “This is not the correct provider, please check your records.” We received an invoice from Healhport for DrD [redacted] ’s records on June 25, and sent payment to them on June 26, 2015.We received a response from DrW [redacted] ’s office on July 1, stating that the authorization that Mrs [redacted] completed must be datedWe sent a new request to DrW [redacted] with the signed authorization on July 2, 2015.We received the records from DrC [redacted] on July 6, 2015.We received the records from DrD [redacted] on July 14, On July 17, 2015, we received an invoice from Healthport for the records from DrW [redacted] ’ officeWe sent payment on that same dateOn August 3, 2015, we still had yet to receive the records from DrW [redacted] (the last set of records needed to complete our review), so MsH [redacted] sent an email to Healthport inquiring of the statusThe records from DrW [redacted] ' office were received on August 4, 2015, but only included records from April of to presentMsH [redacted] called Healthport on that date and advised the representative that we had requested records from April of but had only received records from The representative advised that he would put in the request for the missing recordsMsH [redacted] asked if it could be rushed, as it had been over two months since our initial requestMsH [redacted] called Ms [redacted] on the same date and explained the situationOn August 5, 2015, Ms [redacted] called MsH [redacted] and advised her that she called Healthport and they would be sending another invoice for the missing records and that they would not expedite the sending of the recordsWe received and paid this invoice on August 5, 2015.We received e-mail correspondence from Healthport on August 11, advising that a message has been sent to the field rep to review and scan the missing records as soon as possibleThe representative stated that we should allow 7-business days for the request to be completedOn August 23, 2015, Ms [redacted] called MsH [redacted] and stated that she contacted Healthport, who advised that the records were mailed to us three days agoAs of the date of this letter, the records have not been receivedIn her complaint, Ms [redacted] indicates her desired outcome as, “Resolving issues with claim and Pay claim as requestedHer desired settlement is, “Finish the Job.” As explained above, we cannot make the determination of Ms***’s claim until all of the requested documentation is received and reviewedAs soon as the records from DrW [redacted] are received, Ms [redacted] ’ entire claim file will be reviewed by our medical departmentThis review should take 24-business hoursWe will communicate our decision as soon as we have made itPlease note that the possibility remains that Ms [redacted] may not be entitled to benefits, should we determine that her disability was caused by or resulting from a Pre-Existing Condition, as defined in the policy.Sincerely,Todd D***, Supervisor Group Disability Claims Department

Very poor service. Been trying to get my disability insurance check for over 2 months. Everything I called the insurance company I got little to information or left several voicemail without any one returning my call. My company approved my medical disability but yet I have received any assistance in reference to the payments. Very lousy way to take care of the clients.

May 30, Dear *** ***:Your inquiry dated May 16, (received May 20, 2014), referencing the handling of *** *** Long Term Disability (LTD) claim, has been forwarded to my attention for response, Thank you for the opportunity to address ***'
concerns.The abovementioned policy is a group LTD plan, which provides benefits at 66.67% of the covered employees monthly earnings to a maximum of $5,if he/she (among other requirements) meets the definition of Total Disability as defined by the policyThe policy situs state is Louisiana.According to the documents included with the inquiry filing, *** contacted your office on May 16, for assistance with getting his LTD claim paidAccording to our records, we resolved *** concerns on My 20, when his LTD claim was approvedBenefits have been paid for the period March 5, to March 28, 2014, totaling $1,099.67, A copy of the approval letter sent to *** has been enclosed for your review.We trust our response is sufficient for your needsEnclosed with this correspondence is a copy of *** payment history, group policy and approval letterIf you have any questions, please do not hesitate to contact me directly at ###-###-####

July 9, Dear *** ***:We are writing to acknowledge receipt of the above-mentioned correspondenceWe have forwarded this complaint to the following department at the same address:NAME: *** ***TITLE:
ManagerDEPARTMENT: Integrated Disability Claims###-###-####We are presently looking into this matter and you will be hearing from us shortly.Please note! If at any time you correspond directly with the individual listed above, it would be appreciated if a copy of that correspondence were sent to me as well, so that we can track all correspondence and ensure that timely responses are provided to you.Sincerely,

February 9, 2016Dear *** ***:
We are in receipt of the complaint filed by the customer named in the Revdex.com Complaint ID noted aboveThe above-mentioned policy is a voluntary group disability plan that provides weeks of Short Term Disability benefits at a rate of
60% of an eligible employee's salary.In adjudicating this claim, we needed to determine whether the customers injuries were work related, which is an Exclusion of the planIn addition, we had to determine if the customer's claim was subject to the policy’s Pre-existing LimitationThis policy provides benefits to a covered employee who incurs a period of disability caused by an Injury or Sickness, as defined by the policyHowever, it excludes benefits for a period of disability caused by a Sickness, which is covered by a Workers Compensation Act, or other workers disability law; or Injury, which occurs out of or in the course of work for wage or profitPlease refer to Exclusion provision on page of the policy, which is enclosedAccording to information provided on the claim application, the customer indicates that while working for Chattanooga Kidney Center on June 29, 2015, she was injured after “bending over and putting acid in a wall”Information provided on the Attending Physician Statement, which was completed by DrDayle Hawthorne, indicates that “it’s possible that the claimant’s injury was work related or constantly aggravated by work”In addition to reviewing the medical information to determine the causal connection of the injury to the customer's job, we must also determine if the customer's claim is subject to the policy’s Pre-existing LimitationThe policy explains the Pre-existing Conditions Limitation as follows:PRE-EXISTING CONDITIONS: An Insured will be considered to have a Pre-existing Condition and will be subject to the Pre-existing Conditions Limitation if:(1) the disability begins in the first twelve (12) months after the Insured's effective date; and(2) he/she has received medical Treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines for the Sickness or Injury, whether specifically diagnosed or not, causing such disability, during the three (3) months immediately prior to the Insured's effective date of insuranceWeekly Income Benefits will not be paid for a disability:(1) caused by;
(2) contributed to by; or
(3) resulting from
a Pre-existing Condition unless the Insured has been Actively at Work for one (1) full day following the end of twelve (12) consecutive months from the Insured's effective date of insuranceAccording to the claim information, the customer was hired on November 25, and her insurance under this plan became effective on January 1, Since the customers insurance was in effect for less than months as of the date of her disability, the policy requires that we conduct a Pre-existing investigation to determine if the customer received medical treatment, care or services including diagnostic procedures, or took prescribed drugs or medicines for the Sickness or Injury, whether specifically diagnosed or not, causing such disability, during the three (3) months immediately prior to the Insured's effective date of insuranceOur records indicate this claim was received on October 26, On November 3, 2015, the claims examiner sent a request to the policyholder for the customer's enrollment form and payroll recordsThe requested information was received in our office on November 9, On November 9, 2015, the examiner sent the Pre-existing Investigation letter to the customer, which explains the policy provision as well as a Pre-existing Questionnaire that the customer is to completeIn addition, on November 9, 2015, the examiner sent a request to the attending physician for their medical records.Medical records were received from the attending physician on November 16, On December 21, 2015, the customer's completed Pre-existing Conditions questionnaire was receivedThe questionnaire identified several providers that she consulted with during the Pre-existing investigative period of October 1, to January 1, The physician listed on the questionnaire is the physician that completed the disability paperworkThe customer provided incomplete information regarding her health insurance carrierOn December 28, 2015, the examiner called and left a message for the customer to provide the mailing address for her health insuranceThe customer called back and provided this information on December 29, A request for the health insurance records was subsequently mailed to the provider on December 29, An initial follow up letter was mailed to the carrier on January 13, and a second and final follow up letter was mailed to the carrier on February 3, On February 9, 2016, our office received a response from the customer’s health insurance carrierThe customer was copied on all correspondence that has been mailed in regards to this claimThe customer states in her complaint that we are not investigating and gathering the necessary information to approve her benefitsShe believes we are stalling and not sending benefits to which she purchasedAs noted in the Pre-existing Investigation letter, due to the nature of this investigation and our need to gather additional medical records, the review of the file may require more time than usualHowever, we will strive to complete this investigation as quickly as possible with the customer’s continued cooperationOur review of the claim file reveals that we have requested documentation to satisfy the policy’s requirements of eligibility, workers’ compensation as well as Pre-existing conditionsThe customer has received copies of all of our requests and has been in communication with the claim’s examiner and our Customer Care departmentWhile we understand that the customer has gone without funds for some time and this has caused her financial stress, we have adjudicated this claim in accordance with the Short Term Disability contractBased on our review of the available medical records, it does not appear that the customer received treatment for her disabling condition during the Pre-existing investigation period of October 1, to January 1, However, the medical records reveal that the customer's injuries appear to be work related in nature, Which is an Exclusion of the contractThe records document that due to constant and severe pain, the customer is unable to function and she relates the problem to an incident that occurred on June 29, 2015; as well as repetitive work in different jobs in the dialysis center at her place of employmentTherefore, since her injuries occurred out of or in the course and scope of her employment, benefits are not payable under this Short Term Disability policyPlease be advised that this policy Exclusion, applies regardless of whether or not the customer receives workers’ compensation benefitsAlthough the customer is not eligible for benefits under the Short Term Disability policy, she is eligible to apply for benefits under her employer's Long Term DisabilityWe are currently in the process of establishing a Long Term Disability claim in our system for the customerIf you have any additional questions or concerns, please feel free to contact me directly at (*** *** ***Sincerely,

July 1, 2014Your inquiry dated June 19, (received June 24, 2014), referencing the handling of *** ***s Long Terrn Disability (LTD) claim, has been forwarded to my attention for response, Thank you for the opportunity to address ***s concerns.The abovementioned policy is a
group LTD plan, which provides benefits at a flat rate of 1600,per month to a maximum of 6,if he (among other requirements) meets the definition of Total Disability” as defined by the policyThe policy situs state is Texas.According to the documents included with the inquiry filing, *** contacted your office for assistance with getting his LTD claim paidAs *** advised, we are currently withholding his net LTD payment to satisfy an overpayment that occurred on his Short Term Disability (STD) claimIn our letter to *** dated March 26, 2014, we explained how the overpayment occurred and the policy provisions) that allowed us to recover the overpaymentWe have enclosed a copy of this correspondence for your review, As explained in the above referenced letter, *** has a right to file an appeal on the determination rendered; however, he has not exercised that right to date.In our letter to *** dated April , 2014, we explained that his LTD claim was approved but we were withholding all benefits and applying them to the overpayment that occurred on his STD claimAs of April 1, 2014, the overpayment balance is $7,053.45.At the present time we are unable to determine if *** remains Totally Disabled (and continue to credit his monthly benefit to the overpayment balance) as he has not responded to our request for additional informationIn our letter to *** dated April , 2014, we advised him that additional information was needed for benefit consideration beyond April 1, 2014, on May 21, 2014, we received updated records from ***s primary care physicianThe records indicate *** has been referred to other physicians for treatment; however, we do not have contact information for those physicians on fileIn a letter to *** dated May 28, 2014, we asked him to provide contact information for all physicians he has treated with from April to present*** was further advised that his response was due by June 28, or his claim would be considered incomplete and his file closedWe are beyond the date by which *** was required to respond and the information requested has not been providedWe will grant *** a fifteen day extension (from the date of this letter) to provide the information requested, If the information is not provided by that date, **, ***s claim will be closedIn that event, he will be provided with additional appeal information.We trust our response is sufficient for your needsEnclosed with this correspondence is a copy of the letters referenced above as well as the group policyIf you have any questions, please do not hesitate to contact me directly at ###-###-####

July 23, Dear *** ***:This letter is in response to your inquiry regarding a Long Term Disability (LTD) claim for *** ** ***Thank you for the opportunity to address and respond to *** ***'s COOCCITIS,I have attached our response to the Insurance
Department, State of Connecticut dated April 22, regarding this matterIt outlines our position regarding *** request that we amend and reissue her Wwage statement for 2012.Should you have further questions in regards to the status or handling of *** ***’s claim, please contact our office.Sincerely,Martha M***, LTD Supervisor Group Disability Claims Department

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
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.
Regards,
Eddie Dollgener

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: ***I am rejecting this response because: The company has not accepted responsibilty for causing me a financial lossAttached is a spreadsheet fromn my accountant showing that the mistake cost me to have to pay extra taxes on money I ultimately paid backIf they do not reimburse me soon, I will have no choice but to file a law suit.Regards,*** ***

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved]
Complaint: ***
I am rejecting this response because:
...because of several reasonsFirst of all my medical condition DID (at the time) and DOES (now) meet the requirements of "disability" according to the Reliance Standard definitionSince my condition DOES meet that definition of 'disability' the insurance company has gone to other measures in order to deny my claim, and appealOnce they realized I met the requirements for 'disability' Reliance Standard then pulled out a phrase from the policy which states the "sickness or disability" is defined as pregnancy, abortion or complications of thoseIt's ridiculous that disability and/or sickness be defined as pregnancy or abortion (or complications thereof)! It appears Reliance Standard has a skewed perception of the policy definition of sicknessThirdly, the insurance company has ignored the recommendations of my own Drs (which I gave reports from many) and Reliance Standard hired a physician of their own.
It doesn't matter if they found the physician themselves or if they paid someone else to find herThe important factor is that they PAID her $to give medical information to assist them in denying my appealSeveral statements were in her medical report which she wrote up for Reliance StandardOne particular area in her report the Dr addressed the tenderness of my bodyShe stated, "wasn't really tender" but I remember shrieking and grabbing for her hand at one point due to the tenderness of my hip area when she was examining meShe stated the medical records from my Drs didn't provide sufficient evidence of the disability, but she refused to look at the medical records I brought to her officeShe said very little to me, while typing during most of the office visitShe added her opinion about another a medication my Dr had given me for weight loss which had nothing to do with this case whatsoever, calling it inappropriateMy Dr has been in practice much longer than she- and has known me for many years, making him more aware of how to treat me and my conditionIt's odd that Reliance Standard would use the opinion of a Dr that has examined me once (who was PAID) rather than a Dr who has examined me many times over the years, watched my illness progress, who has watched me fight the disease and the limitations and was NOT paid nearly $2000, but what the insurance would cover for the office visits to himIn addition to the reports I provided from my PCP, were reports from a Rheumatologist, Orthopedic Physician, a Neurologist and several Drs at the *** ***The hired physician for Reliance Standard also added her opinion that it was my own 'life choice' to stop workingThis is not my 'choice' and, in my opinion, not a choice anyone would makeI initially asked for a few vacation days in hopes of recovering and going back to workIt was the supervisor who recommended FMLA papers that begun this entire nightmareShe said that since I was struggling so much this might 'help' meIt has gone downhill from thereNot only did the (non-profit) organization turn their backs on me, the insurance company to whom I had been PAYING for short term disability denies to pay the percentage of my salary stated on our agreementThey had rather pay a Dr insteadWhat they paid her was more than half of what they owe to meThank you for your help in this matter
Regards,
*** *** ***

March 27, 2014
Dear **. [redacted]:We are in receipt of your letter dated March 18, 2014. We appreciate the opportunity to respond to **. [redacted]’s concerns.In responding to your request, please note the disclosure of medical related information is subject to the Health...

Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the accompanying regulations. Thus, we are unable to provide and or release details specific to **. [redacted]’s medical history without her written consent to do so. As a result, we shall provide clarification regarding the basis of the Short-Term Disability (“STD”) denial in absence of any details specific to **. [redacted] medical history.In determining if **. [redacted]’s met the group Policy definition of “Disabled', we reviewed the claim file in its entirety. When we considered the applicable medical evidence we concluded that the information did not substantiate a physical or mental health condition that was at a level of severity precluding **. [redacted] from performing the full-time material duties of her job as of the work stoppage date, September 18, 2013. The remainder of this correspondence further outlines the facts utilized in reaching our decision.The group Policy VPS [redacted] defines “Disabled” as follows:"Disabled' means the Insured is:(1)    unable to do the material duties of his/her job; and(2)    not doing any work for payment which he/she is qualified by education, training or experience; and(3)    under the regular care of a physician.Further, please be advised that the group Policy VPS [redacted] contains the following provisions relevant to this appeal:DA Y BENEFITS BEGIN: Benefits, for one period of disability, will be paid as follows:INJURY AND SICKNESS: We will pay benefits from the fifteenth consecutive day of disability.The DEFINTION section further states:"Injury" means bodily injury resulting directly from an accident, independent of all other causes. The injury must cause disability which begins while an Insured is covered under this Policy"Sickness" means illness or disease causing disability which begins while an Insured is covered under this Policy. Sickness includes pregnancy, childbirth, miscarriage or abortion, or any complications therefrom.Information in the claim file revealed that **. [redacted] last worked for our Policyholder, [redacted] of [redacted], Inc., as a [redacted], on September 18, 2013. Thus, our decision as whether or not **. [redacted] met the group Policy’s definition of “Disabled” was based upon her ability to perform the material duties of her job subsequent to the work stoppage in relation to the medical documentation within the claim file. Upon review, it was concluded that **. [redacted] did not meet the group Policy definition of “Disabled” and, as a result, her claim was denied as of November 27, 2013.**. [redacted] was granted an opportunity to request a review of the original determination by submitting a written request for an appeal, which we ultimately received on January 9, 2014. Upon reviewing **. [redacted]’s appeal request, it was determined that an Independent Medical Examination (“IME”) would be necessary.In arranging an IME, we used a third party vendor, [redacted] (“[redacted]”), who specializes in acquiring independent and evidence based medical opinions. [redacted] identified a physician within a relevant specialty and within a reasonable distance of **. [redacted]’s residence. To maintain the unbiased nature and validity of the IME, RSL had no input regarding the identification of a physician. In fact, RSL and **. [redacted] were notified of the details regarding the exam simultaneously. In addition, RSL does not have dircct communication with the physician in question; all communication is initiated by [redacted] throughout the duration of the IME process. Also, please note that compensation specific to the IME is made payable by RSL to [redacted], who then issues payment to the physician for services rendered after deducting their own fees for arranging the examination. As a result, no forms of direct communication and or compensation are ever exchanged between RSL and the physician acquired to conduct the IME.In regards to **. [redacted], it is noted that the IME was completed as of February 18, 2014. Upon receiving the results of the IME and given the physician’s opinion, we concluded based on our review of all the materials submitted to RSL, **. [redacted] was not considered “Disabled”, as of her September 18, 2013, work stoppage date. Thus she was not entitled to STD benefits in connection with this claim. While we regret that our decision could not have been more favorable to **. [redacted], we were limited by the provisions of the group Policy. **. [redacted] was informed of this decision as of March 21, 2014. **. [redacted] was also instructed that our decision was final as she exhausted any administrative remedies available to her under the terms of the group Policy.We hope this clarifies our claim handling. If you have any questions regarding this matter, please feel to contact me at ###-###-####, extension [redacted].Sincerely,

Oct/28/2014
Dear [redacted]:We are writing to acknowledge receipt of the above-mentioned correspondence. We have forwarded this inquiry to Ms. S[redacted] of our Underwriting Department who has reached out to [redacted] and addressed her concerns, Below is Ms. S[redacted] contact...

information.NAME: Margaret S[redacted] TITLE: Manager, Medical Underwriting and VGTL Departments
TELEPHONE ###-###-####, Extension [redacted]Please feel free to contact us if we can assist you further in this matter,Sincerely,Law/Consumer Relations Department

We are in receipt of your correspondence dated January 7, 2015, regarding a recent complaint against Reliance Standard Life Insurance (“RSL") on January 7, 2015. At this time, we appreciate the opportunity to respond.
Mr. [redacted] submitted a claim for Long Term Disability (“LTD”) benefits...

based upon his stated inability to perform the material duties of his occupation as a Sales Route Drive. The US Department of Labor has categorized this occupation within a Medium range of exertion." Upon receipt of the claim, the LTD Claims Examiner requested extensive medical information, and upon receipt of Mr. [redacted]’s medical records, a review by our internal medical department concluded that Mr. [redacted] was Totally Disabled from his Regular Occupation according the governing Policy, and his claim was therefore approved. Mr. [redacted]'s LTD benefits commenced upon expiration of the applicable Elimination Period, on November 12, 2012. Further, Mr. [redacted] was paid monthly LTD benefits for 24-months, as it was determined throughout the course of his claim, that he remained Totally Disabled from performing the material duties of his Regular Occupation as a Sales Route Driver. His last benefit payment was for the period of October 12, 2014 to November 12, 2014.However, as set forth within the Policy, after payment of LTD benefits for 24-months, the definition of Total Disability changes, and in order for continuing LTD benefits, one must be unable to perform the material duties of Any Occupation, including occupations less physically demanding, such as sedentary work.” Specifically, the Policy provides, in relevant part:CLASS 2, 4, 6 & 8: "Totally Disabled" and "Total Disability" mean, that as a result of an Injury or Sickness:(1) during the Elimination Period and for the first 24 months for which a Monthly Benefitis payable, an Insured cannot perform the material duties of his/her Regular Occupation; (a) "Partially Disabled" and "Partial Disability" mean that as a result of an Injury orSickness an Insured is capable of performing the material duties of his/her Regular Occupation on a part-time basis or some of the material duties on a fulltime basis. An Insured who is Partially Disabled will be considered Totally Disabled, except during the Elimination Period: (b) "Residual Disability" means being Partially Disabled during the EliminationPeriod. Residual Disability will be considered Total Disability; and (2) after a Monthly Benefit has been paid for 24 months, an Insured cannot perform the material duties of Any Occupation. We consider the Insured Totally Disabled if due to an Injury or Sickness he or she is capable of only performing the material duties on a part-time basis or part of the material duties on a Full-time basis."Regular Occupation" means the occupation the Insured is routinely performing when Total Disability begins. We will look at the Insured's occupation as it is normally performed in the national economy, and not the unique duties performed for a specific employer or in a specific locale."Any Occupation" means an occupation normally performed in the national economy for which an Insured is reasonably suited based upon his/her education, training or experience,(See Policy LTD 119239, a copy of which is enclosed).In this regard, at all times during Mr. [redacted]’s claim, it was opined by our internal medical department, based upon Mr. [redacted]’s treatment records, that he was capable of work within a sedentary capacity. Additionally, upon review by our internal Vocational Department, it was determined that there were occupations within Mr. [redacted]’s educational background, training and experience, within the sedentary capacity. As such, his LTD claim was terminated as of November 12, 2014, due to the conclusion that he was capable, at that time, of performing the material duties of Any Occupation, as defined within the Policy and citcd abovc. He was notified of this determination in advance, via correspondence dated July 2, 2014.In accordance with ERISA, RSL does afford its insured’s the right to an appeal, and Mr. [redacted] submitted a written request that the decision to terminate his LTD benefits be reviewed. This appeal was submitted in a timely manner to the Quality Review Unit of RSL. Upon receipt of the appeal, the handling examiner proceeded to review the claim, and extensive medical information contained therein. As part of the processing on the appeal, our internal medical department also reviewed the claim file. Based upon said review, it was determined that an assessment of the medical information by an independent physician would provide the most fair and in-depth analysis for Mr. [redacted]. Essentially, due to the nature of Mr. [redacted]’s medical conditions, as well as extent and nature of the medical information contained within his file, a review by a independent physician was warranted, and would suffice in terms of an evaluation of Mr. [redacted]’s medical status.
In that regard, under the guidelines of ERISA, we pursued an independent Peer Review. Through the use of a third-party vendor, Mr. [redacted]’s medical file was reviewed by [redacted], Jr., D.O. Dr. [redacted] is Board Certified in Physical Medicine and Rehabilitation, a member of the American Academy of Physical Medicine, a member of the American Association of Neuromuscular and Electrodiagnostic Medicine, and a member of the American College of Sports Medicine. Accordingly, while RSL opted to proceed with an independent Peer Review, as opposed to an independent medical examination (“IME”), we arc confident that Dr. [redacted] possessed more than sufficient qualifications in order to thoroughly review Mr. [redacted]’s claim file, and to render a medically supported opinion.
Moreover, it is noteworthy that under the Policy, the burden to prove Total Disability rests upon the claimant. Accordingly, herein, it was Mr. Gclsdorf’s responsibility to provide any and all information he felt supported his position that he was unable to perform Amy Occupation, as defined by the Policy.
Specifically, the Policy provides:
TERMINATION OF MONTHLY BENEFIT. The Monthly Benefit will stop on the earliest of(1) the date the Insured ceases to be Totally Disabled; (2) the date the Insured dies; (3) the Maximum Duration of Benefits, as shown on the Schedule of Benefits page, hasended; or (3) the date the Insured fails to furnish the required proof of Total Disability.(See Policy LTD 119239, emphasis added).As evident and set forth within the Policy, monthly benefits will cease if an insured ceases to be Totally Disabled, and/or fails to providc required proof of Total Disability. Herein, it was determined by both our internal medical department as well as an independent physician, Dr. [redacted], that Mr. [redacted] was capable of sedentary work, and therefore was not Totally Disabled from Any Occupation. In other words, there was insufficient proof submitted to support that he remained Totally Disabled beyond November 11, 2014.At all times during the course of his appeal, Mr. [redacted] had the opportunity to submit information which would support the appeal. Moreover, while we understand and acknowledge that Mr. [redacted] is not satisfied with the determination to terminate his claim for LTD benefits, we are bound by the terms, provisions, and language of the Policy. In that regard, we remain confident that the Peer Review sufficiently addressed Mr. [redacted]’s complaints, via the multitude of medical records. Moreover, to reiterate, ultimately it was Mr. [redacted]’s burden to submit information to in fact prove his Total Disability.In conclusion, upon thorough review of Mr. [redacted]’s claim for continuing LTD benefits, benefits, we remain in our position the claim was properly and appropriately denied.Should you require anything further, please do not hesitate to contact me. I can be reached at ###-###-####, ext. [redacted], or via email at [redacted].Sincerely,Eileen M. B[redacted]
Appeals Supervisor, Quality Review UnitEnclosure
'The US Department of Labor defines “Medium" as Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects, Physical Demand requirements are in excess of those for Light Work
* The US Department of Labor defines “Sedentary” as: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift carry, push, pull, or otherwise move objects, including the human body. Scientary work involves sitting most of the time, but may involve walking or standing for brief periods of time. For example, sitting for up to 1 hour, standing/stretching and resume sitting: walking and standing are required only occasionally and all other sedentary criteria are met.

December 2, 2014Dear [redacted]:We are writing to acknowledge receipt of the above-mentioned correspondence. We have forwarded this complaint to the following department at the same address:NAME: Theresa K[redacted] ????,?. Manager DEPARTMENT: Integrated Disability...

Claims[redacted]We are presently looking into this matter and you will be hearing from us shortly.Please note! If at any time you correspond directly with the individual listed above, it would be appreciated if a copy of that correspondence were sent to me as well, so that we can track all correspondence and ensure that timely responses are provided to you.Sincerely,
Denis B 
Law/Consumer Relations Department

June 2, 2014 
Dear [redacted]:We are in receipt of your letter dated May 23, 2014, which was received in our Law Department on May 28, 2014. Your inquiry has been forwarded to my attention for a response.As part of her complaint, [redacted] recounts what she considers to be a...

difficult claim history with Reliance Standard (our). She cites the fact that her Long Term Disability (LTD) claim has been denied on two separate occasions and that she successfully appealed each time. She states that she had undergone financial hardship due to our adverse determinations on her claim.[redacted] continues towards her ultimate complaint for which she requests resolution; the overpayment that has occurred on her claim. She states, in part, I have now been approved for SSD and they have back paid me. I am now getting letters from Reliance wanting me to refund them the money they have paid. I think this is so wrong that they pray on the week. This Insurance is something that I elected through my employer and money was taking out of my check for it.” [redacted] further states, I do not feel I need to pay back any money that they have given me for disability. This is why we pay premiums.” The desired settlement noted is, Stop Contacting Me.
The group policy number under which [redacted] in insured states, in relevant part:BENEFIT AMOUNT: To figure the benefit amount payable:(1) multiply an Insureds Covered Monthly Earnings by the benefit percentages), as shown on the Schedule of Benefits page;(2) take the lesser of the amount:(a) of step (1) above; or(b) the Maximum Monthly Benefit, as shown on the Schedule of Benefits page, and (3) subtract Other Income Benefits, as shown below, from step (2) above.We will pay at least the Minimum Monthly Benefit, as shown on the Schedule of Benefits page.OTHER INCOME BENEFITS; Other Income Benefits are benefits resulting from the same Total Disability for which a Monthly Benefit is payable under this Policy. These Other Income Benefits are:(1) disability income benefits an Insured is eligible to receive under any group insurance plans), -(2) disability income benefits an Insured is eligible to receive under any governmental retirement system, except benefits payable under a federal government employee pension benefit;(3) all permanent as well as temporary disability benefits, including any damages or settlement made in place of such benefits (whether or not liability is admitted) an Insured is eligible to receive under:(?) Workers' Compensation Laws;(b) occupational disease law;(c) any other laws of like intent as (a) or (b) above; and(d) any compulsory benefit law;(4) any of the following that the Insured is entitled to receive from you:(?) wages, excluding the amount allowable when engaged in Rehabilitative Employment; and(b) commissions or monies, including vested renewal commissions, but, excluding commissions or monies that the Insured earned prior to Total Disability which are paid after Total Disability has begun(5) that part of disability or Retirement Benefits paid for by you that an Insured is eligible to receive under a group retirement plan; and(6) disability or Retirement Benefits under the United States Social Security Act, the Canadian pension plans, federal or provincial plans, or any similar law for which:(?) an Insured is eligible to receive because of hisher Total Disability or eligibility for Retirement Benefits; and(b) an Insureds dependents are eligible to receive due to (a) above.Disability and early Retirement Benefits will be offset only if such benefits are elected bythe Insured or do not reduce the amount of hisher accrued normal Retirement Benefits then fundedRetirement Benefits under number (6) above will not apply to disabilities which begin after age 70 for those Insureds already receiving Social Security Retirement Benefits while continuing to work beyond age 70.Benefits above will be estimated if the benefits:(1) have not been applied foror(2) have not been awarded; and(3) have been denied and the denial is being appealed.The Monthly Benefit will be reduced by the estimated amount. If benefits have been estimated the Monthly Benefit will be adjusted when we receive proof(1) of the amount awarded; or -(2) that benefits have been denied and the denial cannot be further appealed
If we have underpaid the Monthly Benefit for any reason, we will make a lump sum payment. If we have overpaid the Monthly Benefit for any reason, the overpayment must be repaid to us. At our option, we may reduce the Monthly Benefit or ask for a lump sum refund. If we reduce the Monthly Benefit, the Minimum Monthly Benefit, if any, as shown on the Schedule of Benefits page, would not apply.
As the above policy provisions state, we are to subtract any disability or retirement benefits that an insured is eligible to receive under the United States Social Security Act from the LTD benefit amount. In our initial telephone interview on January 26, 2012, we discussed this provision with [redacted] and explained to her that her LTD benefit would be reduced by any amount that she is eligible to receive from the Social Security Administration. We further explained that the policy affords us the right to estimate the amount that she would be eligible to receive for Social Security Disability Income (SSDI) and to reduce her LTD benefit by this amount.
Upon the approval of her LTD claim, we sent [redacted] a letter dated March 23, 2012 reiterating that the policy allows us to reduce her LTD benefit payments by the amount of any estimated SSDI benefits for which she may be eligible. We explained that if she wished to receive her full LTD benefit without this estimated reduction, she needed to provide us proof that she has applied for SSDI and a completed Reimbursement Agreement. We further explained that in the event that her request to waive the estimated offset is approved, an overpayment may result if she or her dependents are awarded benefits from the Social Security Administration. We continued to explain that in the event of a benefit overpayment, she would be required to reimburse us in full within 15 days of her receipt of the notification by us.
[redacted] signed and dated the Reimbursement Agreement on April , 2012 (see attached copy). The Reimbursement Agreement is a formal request from [redacted] for Reliance Standard to waive any estimated SSDI offset and to pay the full LTD benefit with no reduction. By signing and dating the Reimbursement Agreement, [redacted] acknowledged the terms listed in the agreement, which includes a statement that she must reimburse us for the full amount which may be overpaid to her in the event that she is awarded SSDI benefits, including retroactive awards.On July 30, 2013, we contacted [redacted] by telephone and advised her that we were in need of an update on the status of her SSDI application. She stated that she spoke with her attorney three weeks prior and was told her appeal may be reviewed sometime in September. We requested that she contact her attorney and have them send us a letter indicating at what stage of the application process she was at. On July 31, 2013, we received a letter from her attorney revealing that the SSDI application was pending.
On April , 2014, [redacted] contacted us to advise that she was awarded SSDI benefits and would forward a copy of the award letter to us. We received the Notice of Award letter from the Social Security Administration on April 14, 2014.
We sent a letter to [redacted] dated May , 2014 which explained that due to her entitlement to SSDI benefits that began on July 1, 2012 at the rate of 1,969.00 per month, her claim has been overpaid in the amount of 35,480.27 for the time period of June 3, 2012 to April 3, 2014.
As explained above, the policy stipulates that we have the right to recover the overpayment that has occurred on [redacted]LTD claim. [redacted] does have the right to file a formal appeal within 180 days of his receipt of the May , 2014 letter. It should be noted that we did receive a formal appeal from [redacted] on May 16, 2014. The file has been sent to our Appeals Department for review. We will not take further action in collecting any debt that is owed us until our Appeals Department has completed their review of the file. Once the review is complete, we will continue to request repayment of any debt that is owed us.
Sincerely,

We are in receipt of your letter dated August 7, 2015, which was received in our office on August 12, 2015. Your inquiry has been forwarded to my attention for a response.In her complaint, Ms. [redacted] states that she underwent surgery on June 6, 2015. She filed her claim...

on May 21, 2015 and has yet to receive a payment. She states that her doctor’s office advised her that we repeatedly filed the incorrect papers to the wrong doctor’s office, with the incorrect doctor names for pulling her records. She was also informed that the papers that were submitted were not filled out in their entirety. Ms. [redacted] states that she returned to work early because she could not afford to be without pay any longer. She is concerned that her early return to work threatens her surgery and that she is jeopardy of losing her property because of nonpayment.The group policy under which Ms. [redacted] in insured states, in relevant partPRE-EXISTING CONDITIONS: An Insured will be considered to have a Pre-existing Condition and will be subject to the Pre-existing Conditions Limitation if(1) the disability begins in the first twelve (12) months after the Insured's effective date; and(2) an Insured was diagnosed or treated by a legally qualified Physician with consultation, advice or Treatment occurring during the three (3) months immediately prior to the Insured's effective date of insurance.
Weekly Income Benefits will not be paid for a disability:
(1) caused by or (2) resulting from a Pre-existing Condition unless the Insured has been Actively at Workfor one (1) full day following the end of twelve (12) consecutive months from the Insured's effective date of insitrance.We received Ms. [redacted]’ claim on May 14, 2015. Upon our initial review of her claim, it became evident that we needed to conduct a pre-existing condition investigation. Ms. [redacted]’ claimed date of disability was April 22, 2015 and the effective date of her insurance was July 1, 2014. As her claimed date of disability is within the first 12 months from her effective date of insurance, we need to determine if she was diagnosed or treated by a legally qualified physician with consultation, advise or treatment occurring during the time period of April 1, 2014 to July 1, 2014 (the three months immediately prior to her effective date of insurance), for a condition that caused or resulted in her disability.
It should be noted that a pre-existing condition investigation is sometimes a lengthy process. There are a number of variables that could affect the amount of time that the review takes, including, but not limited to, the number of providers that treated the claimant during the three months prior to the insurance effective date, and the length of time that it takes for the providers to send the records to us. The following summary of the timeline of events will show that in the case of Ms. [redacted]’ claim, any delays in processing are due to the length of time that it has taken her treating physicians to provide the requested documentation to us.On May 19, 2015, we sent Ms. [redacted] a letter explaining our need to conduct the pre-existing condition investigation, along with a form (Pre-Existing Condition Questionnaire) which asked her to provide the contact information for any physician, hospital, and/or pharmacy that would have treated her for any condition for the time period of April 1, 2014 to July 1, 2014. On the same date, we sent a request for all medical records from April 1, 2014 to present to Dr. W[redacted], the physician who completed the disability claim form.
We received the completed Pre-Existing Condition Questionnaire from Ms. [redacted] on May 26, 2015. On May 27, 2015, we sent requests for records for April 1, 2014 to present to Dr. W[redacted] and Dr. Allen W[redacted]. On June 4, 2015, as we had yet to receive a response from Dr. D[redacted], we sent a second request to his office. On June 8, 2015, we received a response from Dr. D[redacted]’s office ([redacted]) advising that the Reliance Standard Authorization for Use in Obtaining Information form that Ms. [redacted] completed to release records to us was not acceptable to their office because the authorization was not dated. The claims Examiner, Courtney H[redacted], called Ms. [redacted] on that same date and advised her of the response from Dr. D[redacted]’s office. Ms. [redacted] stated that she still had a copy of the authorization and would date it and return it to our office. We received the dated authorization on June 9, 2015 and sent it to Dr. D[redacted]’s office.
On June 11, 2015, we had still not received a response from Dr. C[redacted] or Dr. W[redacted]. As such, we sent second requests to their offices. On June 17, 2015, we received a response from Dr. C[redacted]’s office stating, “Dr W[redacted] has not seen this patient since 2014.” However, on the same date, we received an invoice from Healthport, the medical records copying service for Dr. C[redacted]’s office, for 26 pages of records. We sent payment to Healthport for the records. On June 18, 2015, Ms. H[redacted] called Dr. C[redacted]'s office and advised that we were in receipt of their response, but our request did in fact as for all records from April of 2014 to present. The representative at Dr. C[redacted]’s office asked us to send the request to them again. Quite strangely, we received another response from Dr. C[redacted]’s office on June 22, 2015 stating, “This is not the correct provider, please check your records.”
We received an invoice from Healhport for Dr. D[redacted]’s records on June 25, 2015 and sent payment to them on June 26, 2015.We received a response from Dr. W[redacted]’s office on July 1, 2015 stating that the authorization that Mrs. [redacted] completed must be dated. We sent a new request to Dr. W[redacted] with the signed authorization on July 2, 2015.We received the records from Dr. C[redacted] on July 6, 2015.We received the records from Dr. D[redacted] on July 14, 2015.
On July 17, 2015, we received an invoice from Healthport for the records from Dr. W[redacted]’ office. We sent payment on that same date. On August 3, 2015, we still had yet to receive the records from Dr. W[redacted] (the last set of records needed to complete our review), so Ms. H[redacted] sent an email to Healthport inquiring of the status.
The records from Dr. W[redacted]' office were received on August 4, 2015, but only included records from April of 2015 to present. Ms. H[redacted] called Healthport on that date and advised the representative that we had requested records from April of 2014 but had only received records from 2015. The representative advised that he would put in the request for the missing records. Ms. H[redacted] asked if it could be rushed, as it had been over two months since our initial request. Ms. H[redacted] called Ms. [redacted] on the same date and explained the situation. On August 5, 2015, Ms. [redacted] called Ms. H[redacted] and advised her that she called Healthport and they would be sending another invoice for the missing records and that they would not expedite the sending of the records. We received and paid this invoice on August 5, 2015.We received e-mail correspondence from Healthport on August 11, 2015 advising that a message has been sent to the field rep to review and scan the missing 2014 records as soon as possible. The representative stated that we should allow 7-10 business days for the request to be completed. On August 23, 2015, Ms. [redacted] called Ms. H[redacted] and stated that she contacted Healthport, who advised that the records were mailed to us three days ago. As of the date of this letter, the records have not been received.
In her complaint, Ms. [redacted] indicates her desired outcome as, “Resolving issues with claim and Pay claim as requested. Her desired settlement is, “Finish the Job.” As explained above, we cannot make the determination of Ms. [redacted]’s claim until all of the requested documentation is received and reviewed. As soon as the records from Dr. W[redacted] are received, Ms. [redacted]’ entire claim file will be reviewed by our medical department. This review should take 24-48 business hours. We will communicate our decision as soon as we have made it. Please note that the possibility remains that Ms. [redacted] may not be entitled to benefits, should we determine that her disability was caused by or resulting from a Pre-Existing Condition, as defined in the policy.Sincerely,Todd D[redacted], Supervisor Group Disability Claims Department

---------- Forwarded message ----------
From: [redacted] <[redacted]>
Date: Fri, May 2, 2014 at 11:48 AM
Subject: complaint ID...

#[redacted]
To: [email protected]
To whom it may concern:
 
Please note that the company finally settled this matter with me on their own as of this morning. Thank you. 
--
Best regards, 

[redacted], Esq.
Phone: ###-###-####
Fax: ###-###-####
[redacted]

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted] [redacted]