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Dimitry K., Esq.
Dimitry K., Esq., Attorney
Category: Legal
Satisfied Customers: 41221
Experience:  Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
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My mother and father have the same cancer policy, she was the

Customer Question

My mother and father have the same cancer policy, she was the first to use it and they paid right away.however she didn't make it. My father has had cancer in the same area 3 different times but it's been over two years and he hasn't got a dime from them. We've sent in everything they've asked for including a 100 pages of medical records they requested each time they take forever to answer WHEN they do answer. In their policy they are supposed to get an initia $2500 to help them out unti their claim is finalized. My mother got her's immediately but my father has yet to get his after 2 years. I have sent in 85% of the forms so I know everything was sent that was needed. They say they are waiting on a diagnostic report that I requested from Moffitt Cancer center, that was back in April and we have yet to hear from his insurance policy My father made me as the person to help with the claim and at the end of it they say they can't give me anymore information. It sounds ike they have no in-tension of paying his claim and he has already had to have his cancer cut out several times, each operation worse than the other. Do we have any recourse? I want to send them a letter implying that he is going to get a lawyer if this isn't finished up and if not "WHY". I have been looking for a template letter that sounds more official than what I could write and he does plan on getting a lawyer if this isn't cleared up soon. Is there any way you or someone you know could help me or at least somemone who can write the letter for us? All of this is causing him much stress and at his age 72 is very bad for his heath. He has bad diabetes and other heart problems and can't fight the insurance companies and they know that. I have all the emails I've sent them andd their replies. I'm afraid he's going to die before I help him get this cleared up. This claim should have been pai over a year ago. Please help us or referr us to someone who can . We especialy need someone to write the letter to us because it's just us again an insurance co. They've had this policy for over 30 years. Thank you so much. I'm going to call Moffitt an see if they sent out the report they needed it they haven't I'm sending them a letter also for holding up the claim. I am disabed so I can only do so much for him and I know they are not being fair, they've already had to cut out cancer deep in his lip and the second time they had to go even farther causing part of his face to be paralyzed in several places and now they think they may have to go even deeper. The insurance co is trying to say it's not deep enough to quality as cancer, what? they already had to take out 32 nodes in his neck and each time it leaves him a little more disfigured.. I don't have a lot of money but I'll pay what I can just to help him out. I think it's disgraceful what they're doing to him. He's never missed a payment on his premiums and they're making him suffer this way especially after he ost his wife from the same thing. Thank you so much for any help. I will pay for a form letter from a lawyer to shake them up and if they don't respond to this then he is going to get a lawyer to help him, he's gone through so much pain and suffering becuase of them and I hope he get's what he deserves and they get what they deserve for trying to cheat him out of his insurance. Sincerey, Dora Kenney, daughter of Albert H. Clendenen.
Submitted: 1 year ago.
Category: Legal
Expert:  Dimitry K., Esq. replied 1 year ago.
Thank you for your post, Dora. Please permit me to assist you with your concerns.
I am genuinely sorry to hear all this. I am assuming that this is your insurance that is balking at the payments, or is this a third party?
As far as our assistance here, I can help edit your work but if you are looking at a letter with attorney letterhead on it, that is something we cannot provide. Please advise on what you may need and I will do my best to help.
Customer: replied 1 year ago.
Thank you, ***** ***** insurance company is the one that's balking at payments. I do not need letterhead from a lawyer just something that sounds professional and to llet them know that we have cooperated with them and provided everything they needed except the information that Moffitt could not legaly send or release to me or thier client Albert H. Clendenen and it had to be requested from Liberty National Insurance from Moffitt Cancer center. When I informed the insurance co of the cancer center said , they refused to request the info from Moffitt and that we had to do it ourselves. The said they did not do that, moffitt stated they have to do it legally so at that point we sent the papers that Liberty Ins. sent us to fill out and sent them to Moffitt. Moffitt sent the papers back stating that we put the wrong address on. I re-sent the information to Moffitt. along with a copy of the envelope that Liberty Ins. had sent to us. I called the Ins. co and they told me I had the wrong address for them I told them I sent it to the address they GAVE me (I have all that information) Like I said I have tons of emaills and corrospondense between all of us. Do you think my father would have a possible case where he could try to sue them? Any denials of claims that we got were only for information that they said they needed. If he has a case he needs to sue them for all the days he had to drive to tampa, Fl sick to get his Chemo & radiation treatmenst while he was still working. It was an aweful thing to put someone through everyday for months. He's waited over 2 years for an answer and they rarely contacted him to let him know how the cllaim was progressing. At the end of the claim, which is now, they refused to talk to ME about his claim anymore! I told them that they worked with me through my whole mother's claim up until she died and all of his up to now, between both of them we're talking about 5-6 years. It sounds to me like they just don't want to pay the claim. Basicaly he needs a letter to let them know that he will sue them without coming right out and saying it. I think we have enough proof between all the emails, papers, etc. to prove they are ignoring him. Pershaps you know of a great lawyer that he could visit and make them pay for the court costs. I don't know, you are the lawyer so you tell me and if you could draft me a letter I can fil in the blanks, maybe it will scare them into getting on the ball. Let me know if you need anymore info. Dora J Kennedy P.S I spoke with Christine at Moffict Cancer Center in Tampa. if you need any info from her I also have her email address.
Expert:  Dimitry K., Esq. replied 1 year ago.
Let me first address the question for suit. I cannot answer that and neither can any ethical attorney before we review the contract and what is (and what isn't) covered. So far it does sound that if they are refusing to honor terms and are demanding the same documentation back and forth that it appears to be potential 'bad faith' breach, but it also depends on what was sent to them, what was received, and what is legitimately missing. This is not a defense of the insurer, merely what has to be reviewed first I also agree that it sounds like excuses. Now, I can draft a professional blurb for you which you can then edit and fit in the blanks, and if that works, I will forward an 'additional services' request for the work. But again, without reviewing the actual contract it is hard for me to give you a definitive although it surely appears to be bad faith on this end.
Dimitry, Esq.
Customer: replied 1 year ago.
are you saying you need aI copy of the cancer policy? If so I can get it. I got online at the patient portal and all their documents, notes, etc are on there so if theres something they need all they have to do is request it from them but I told them that Moffitt told "Me" there is no reason they can't do that but the insurance co told me "They don't do that" Isn't it their job to get the information needed from his doctors instead of making me (his daughter) responsible for producing ALL the paperwork for his claim? When my mother had her claim I did it all with one person over emai and I didn't have to send them anything except some of the bills. If you could just write up a "blurb" lol...I would appreciate it. So far they've never stated that anything wasn't covered except the first time he got cancer in his lip, which they had to cut a chunk of his lip out to remove the cancer. A few months later the cancer had spread farther down in his lip, now his last operation has left his face a little disfigured because they had to do extensive surgery in the same area which had spread to not only his lip but his neck and cllose to his ear. They had to cut all along his marionette line, his neck and several other places and they don't want to say that the cancer isn't bad enough? According to the policy they are suppose to get $2500 to help them as soon as a claim is started. My mom got her's right away, he is yet to get his and it's been about 2 years. I've emailed them about several times, actually I've emailed them a ton of time and I also sent documents that they deem as important "overnight" to make sure they got them. I sent them a 100 pages of his medical records from moffitt and the last thing I sent was a form they needed to Finish the claim. Moffitt requested him sign a form to send information to his insurance co. Moffitt sent it back stating it was the wrong address so I called his insurance co about it and they said "Oh you have the wrong address" I ask them why did they send me their envelope and letterhead with the wrong address? Finally I got that straightened out that's the last I've heard from them, around April/May 2015. It's caused him and me a lot of stress which is not good for someone with cancer. I'm disabled myself so working on this for 2 years is just not acceptable from any company. I do have tons of paperwork and emails so if he has to get a lawyer we can prove all of this stuff. My father has also been hit in a car accident which has really hurt his back, diabetes, heart problems and many other medical conditions. He's 72 and wants to retire as soon as this claim is finished. Thanks for your help. I can't afford to pay another $52 to talk on the phone because I'm 64yrs. and on a fixed income. It would be great to talk to you I think you could get more information from me, it's hard typing all of this because I have arthrisus in my fingers. Like I said, it was his idea for me to write a letter and sort of insinuate that if this isn't resolved soon he's going to get a lawyer and maybe they will finish this up for him before he dies. If you need anything else let me know and I'll send them to you. Thank you Dora Kennedy
Expert:  Dimitry K., Esq. replied 1 year ago.
It is actually your job to ensure that the insurer receives all information, which I agree is maddening because the insurer is not ultimately invested in covering, but is instead invested in limiting their own liability. As far as the policy, yes, an attorney has to review it and see where and how they are potentially in breach. In this situation asking me to review is no problem, but it would be at an additional charge because contractual review can be very time consuming and is simply beyond the scope of the initial question. But perhaps you can review it yourself--find their language on what is covered pertaining to cancer treatment and benefits, and then write them a letter directly quoting and citing their own sections. This is likely the best way for you, short of an attorney to get the coverage that you are entitled to.
Dimitry, Esq.
Customer: replied 1 year ago.
No, Iike I said I personally don't have any extra money so can you just write me a general letter like you said before and I will fill in what I need to. I have to get it in, I was suppose to write it a week ago but I thought I'd talk to someone first about a letter and then see what thier response is and after that my dad will take some other action. I hope the money I;'ve spent hasn't been in vain. Let me know and send the letter to my email address:***@******.*** I thought this would only take a day or two but it's turning into a week. Thanks for your help.. No use talking on the phone there's nothing else to telll you at this point.
Expert:  Dimitry K., Esq. replied 1 year ago.
If you are seeking an additional service such as a letter I will do my best to draft it, but as it is an additional work, I will forward you a request for additional service to get it done. Hold on, please.
Customer: replied 1 year ago.
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