How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask N Cal Attorney Your Own Question
N Cal Attorney
N Cal Attorney, Attorney
Category: Consumer Protection Law
Satisfied Customers: 9261
Experience:  since 1983
9653905
Type Your Consumer Protection Law Question Here...
N Cal Attorney is online now
A new question is answered every 9 seconds

Need help with declined disability insurance claim

Customer Question

Need help with declined disability insurance claim
Submitted: 1 year ago.
Category: Consumer Protection Law
Customer: replied 1 year ago.
I have history of depression and anxiety but always under control with meds and therapy. Had nervous breakdown in Jan 2015 and was rediagnosed as bipolar. Hospitalized twice, attended 3 2 week outpatient programs 3 ER visits, new meds and my life is out of control. Nothing like ever before. I had a great job for 12 years that I was successful at, several promotions, raises and never ever experienced anything remotely close to this but insurance company declined my claim due to pre existing condition.....even though re diagnosed and new symptoms, new meds, new treatment plan etc. can I fight this? Any tips?
Customer: replied 1 year ago.
Also, this is an employer paid policy and I never received any docs stating the pre existing condition clause in the verbiage.
Customer: replied 1 year ago.
Sorry, employee paid not employer
Expert:  N Cal Attorney replied 1 year ago.

I am sorry to hear this.

In which State are you located?

Do you have a copy of the policy?

Did the insurer deny the claim in writing?

If so, what did the denial letter say?

Customer: replied 1 year ago.
Here is the declination in writing...Hi Melissa,
Thank you for your patience and cooperation while we completed our review. The review of your claim for benefits has been completed and we have determined that your mental conditions (depression, anxiety, ADHD and bipolar disorder) are preexisting conditions and therefore excluded from coverage for benefits.
A decision letter and a copy of the group policy will be sent to you on 10/15/15 . In our letter we explain your right to request a review of the decision to deny your claim. If you request a review you will need to submit your request in writing and note the reasons you feel the decision to deny your claim was inaccurate. You also have the opportunity to submit additional medical information you feels supports that your conditions are not preexisting.
Given the length of time you have been off of work I recommend that you apply for Social Security Disability benefits. You should be able to apply for the benefits online-start the application process.
Take care
Michelle Brunswick | Sr. Disability Benefits Analyst
Northwestern Mutual
920 SW Sixth Avenue PSB6A | Portland, OR 97204
Phone(###) ###-#### *****(###) ###-####Toll-Free(###) ###-####x2473
Ensure a sustainable future - only print when necessary
Customer: replied 1 year ago.
I live in Massachusetts
Customer: replied 1 year ago.
I can send the policy verbiage to you tomorrow. Is that okay?
Customer: replied 1 year ago.
The new bipolar diagnosis that has turned my life upside down is in no way a pre existing condition. It was never discussed or treated until this year.
Expert:  N Cal Attorney replied 1 year ago.

Yes, if you want to, you can post it here or email a copy to***@******.*** and write For N Cal Atty as the subject line.

I have little doubt that the insurer is acting in bad faith, see

https://www.healthcare.gov/health-care-law-protections/pre-existing-conditions/

which states:

"The only exception to the pre-existing coverage rule is for grandfathered individual health insurance plans -- the kind you buy yourself, not through an employer. They don’t have to cover pre-existing conditions."

But bipolar disorder is not depression, anxiety or ADHD and the insurer is just speculating that you were bipolar before you got that diagnosis.

You can get a free consultation from some of the insurance bad faith lawyers listed by location here.

The insurer called it a group policy, not an individual policy, which suggests that the preexisting condition exclusion might not be grandfathered.

You are going to need a local attorney to review the policy and all the correspondence to and from the insurer, but I think the insurer is acting in bad faith.

I hope this information is helpful.

Customer: replied 1 year ago.
The info you sent me and referred to in your email is regarding health insurance. I was asking about disability.
Expert:  N Cal Attorney replied 1 year ago.

Does the policy cover ONLY disability?

Customer: replied 1 year ago.
as mentioned in my original request, this is in regards ***** ***** disability income insurance claim.