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I had had an operation on 14-12-2017, paying the hospital,

Hi Deborah, i had...

Hi Deborah, i had had an operation on 14-12-2017, paying the hospital, surgeon, anaesthetic specialist and physiotherapist myself.

Lawyer's Assistant: What state/territory are you in? It matters because laws vary by location.

Queensland. I forwarded the receipts, etc to my private health insurer on 5-12-2017, only a week before the expiry of the two year period in which to claim. My insurance company, Health. Com, are now refusing to accept my claim as they state they didn’t receive it until early January 2018, although they emailed me on 8-12-2017 re details. there is about $12,500 involved and I can’t afford to lose that money. I didn’t make the claim earlier as I mislaid the paperwork, and have some memory problems, which forced me to retire at 55. i would appreciate your assistance.

Lawyer's Assistant: What steps have you taken so far?

I have forwarded the receipts etc to Medicare, also on 5-12-2017 and they have only this month deposited their contribution, $713:00, to my bank account, but have not mailed me any documentation. They just rang to advis3 me that they had made the deposit.

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Answered in 7 minutes by:
3/28/2018
John Melis
John Melis, Lawyer
Category: Australia Law
Satisfied Customers: 3,335
Experience: Principal Lawyer at Legal AU Pty Ltd
Verified

Hi, my name is***** solicitor in Melbourne. Thank you for using Just Answer, and I will answer your question today, and ask various questions to narrow the issues in your post raised.

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Customer reply replied 3 months ago
Hi John,I hope you can help.

do you still have a copy of the email you sent on 5/12/2017

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Customer reply replied 3 months ago
I am starting to disbelieve the proffered $5:00 trial offer. Please respond via email.
Customer reply replied 3 months ago
Let me have your email address and I will forward a copy of the express post, registered letter I sent to Health.com.

As long as you can prove that the mail was issued with the receipts in it, which can be done by affidavit, your claim will stand strong in the court against the insurer.

The insurance company will attempt to deny the claim on the basis of what you said, however, you can also call for an internal investigation with the insurer and ombudsman in relation to the assess their internal operation.

On the facts you have stated, you have a valid claim to rise and to seek the refund of the medical expenses.

Does this answer your important question today ?

If you need any further information please let know.

You can come back to this post any time to ask questions and there will be no further charges to you.

Don’t forget to rate me 5 stars as this supports me helping the community, and thank you for using Just Answer.

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Customer reply replied 3 months ago
Other than the letter advising that the receipts are enclosed, how do I prove their enclosure? The email on 8-12-17 from their staff member confirmed receipt of the details, so I guess that is proof enough.
And how do I contact the ombudsman?Thanks David

David you can prove this by having a affidavit drafted which supports the claim made.

The insurer will give you a good fight, you can succeed on the evidence that you stated.

John Melis
John Melis, Lawyer
Category: Australia Law
Satisfied Customers: 3,335
Experience: Principal Lawyer at Legal AU Pty Ltd
Verified
John Melis and 87 other Australia Law Specialists are ready to help you
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Customer reply replied 3 months ago
Thanks, ***** ***** five stars.Cheers Dave

you are most welcome.

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DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.

The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

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