LTD and Evidence of Insurability

[mwalla]

Hello,

I have long-term disability insurance through my employer. I became employed in 2010, but elected to have supplemental, buy-up coverage in 2012. (core benefit covers 50% of my salary, buy-up covers an additional 16%). Now that I am making a claim for disability, the insurance provider is denying me the buy-up portion because I did not provide evidence of insurability (EOI). They are making payment on the core benefit, just not the buy-up portion.

I feel that I also deserve the buy-up coverage because: 1) I never received a request for EOI and 2) I was paying into the program from 2013 through 2016 and could reasonably assume I was covered because the insurance company was collecting payment over multiple years.

Any suggestions on how to get the insurance company to pay at the bu-up rate?

Thank you

 

[glgamerica]

Hello,

I have long-term disability insurance through my employer. I became employed in 2010, but elected to have supplemental, buy-up coverage in 2012. (core benefit covers 50% of my salary, buy-up covers an additional 16%). Now that I am making a claim for disability, the insurance provider is denying me the buy-up portion because I did not provide evidence of insurability (EOI). They are making payment on the core benefit, just not the buy-up portion.

I feel that I also deserve the buy-up coverage because: 1) I never received a request for EOI and 2) I was paying into the program from 2013 through 2016 and could reasonably assume I was covered because the insurance company was collecting payment over multiple years.

Any suggestions on how to get the insurance company to pay at the bu-up rate?

Thank you

I'm assuming that when you enrolled, you received some sort of confirmation of what benefits you enrolled in at the time. I would look for that to see what the enrollment confirmation said.

So step one, see if you can find your enrollment confirmation to confirm you did enroll in the LTD for the amount you thought you did. If you don't have it, someone might.

Keep in mind, LTD enrollment is probably an annual thing which you confirm each year. Also if your employer changed disability carriers some where along the line, your original 2012 election might not have automatically carried over because they might have adjusted the program in a takeover situation. So you would probably need those enrollment documents as well. Takeovers sometimes have provisions that allow participants to be grandfathered in with the new company. This means you'd need your enrollment forms for 2012-2016 and it would help to have the literature you received each year if any that outlined the plan you selected.

Step two, contact your human resources department if you have one and let them know what your problem is. They might solve it for you. If not ask them who the group insurance broker is and contact them and walk them through what the problem is and see if they can solve it. Sometimes, brokers that do a significant amount of business with one carrier can get problems like that fixed. I know I've been able to do that. This is especially true if you did everything you were supposed to do like you alluded to in your post.

Step three, ask for any correspondence from anyone requesting the EOI. It does happen that EOI is requested and people ignore it, miss it, etc. If the insurance company did in good faith request it but the company never changed your deduction - which can happen - it isn't really the insurance company's fault.

In those cases, depending on the players involved, the insurance broker and your employer sometimes solve the problem some other way.

Remember that after several years, it is tough to remember what was verbally said. I know when I do enrollments for companies that while I mention all of the rules to employees, it's hard enough to remember all of those rules let alone expect the employee to remember all of them as well.

This is why your paper trail of enrollment confirmations is important. Just pointing out your deduction probably isn't enough. That could just be a payroll error.

If after you have gone through the steps, your problem isn't solved and if it looks like the insurance company is at fault, collect your evidence and file a complaint with your states insurance department.

I hope you get it resolved. Good luck healing up.