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Disability insurance company refusing to convert policy, now have no coverage Texas

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by JenG, Oct 2, 2019.

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  1. JenG

    JenG Law Topic Starter New Member

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    Jurisdiction:
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    I was misinformed about being able to convert my group disability insurance policy to an individual policy by my disability insurance company. I was told told when I first signed up in Sept 2018 that I could if I found a new job. I got pregnant knowing that I was covered if I switched jobs (because I'd be able to convert). I got a new job and in August I called to confirm I could convert and begin process. I began paperwork as did my previous employer and on Sept 18 I was told I could not convert my policy. After investigating they admitted they misinformed me but said they couldn't do anything. By this time it was too late to sign up with my current employers disability, now I am 6 1/2 months pregnant with no coverage for maternity leave. Can I take any legal action? I was completely misinformed which led to me missing the sign up window for my new employer. I also can not sign up for an individual policy with anyone else because I'm already pregnant, even for non-pregnancy related issues.
     
  2. hrforme

    hrforme Active Member

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    who misinformed you and how? do you have anything in writing?
     
  3. army judge

    army judge Super Moderator

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    Of course, you have the "alleged misinformation" in writing, correct?

    That could be useful.

    If, however, you don't have the "alleged misinformation" in written form, I think you will have great difficulty in changing anything.

    Again, do you have the "alleged misinformation" in writing?

    If not, then you probably have little wiggle room or recourse.


    I believe you meant to type "I got pregnant BEING MISINFORMED that I was covered if I switched jobs", right?


    If that is true, and you have it in WRITING, you can start your remedial process by reporting the matter to TDI (Commissioner), read all about it on their website:

    https://www.tdi.texas.gov/consumer/get-help-with-an-insurance-complaint.html

    I don't guarantee any specific outcome, just that you have the RIGHT to file a complaint. The rest will be in the hands of our state Insurance Commissioner.
     
  4. JenG

    JenG Law Topic Starter New Member

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    The customer service reps I spoke with (at least 4 different ones I spoke with) as well as the person I initially signed up with. I do have a letter from them saying that they did find that they misinformed me but they can't help me.
     
  5. zddoodah

    zddoodah Well-Known Member

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    Sure you can, but you're not likely to get a resolution any time soon.

    A question for you: How is it that you didn't catch the misinformation when you reviewed the policy documentation either before buying the policy or immediately thereafter?
     
  6. JenG

    JenG Law Topic Starter New Member

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    I never got a copy of the policy just a packet which doesn’t mention conversion. Not even my employer has a copy. I asked them repeatedly for one and they quoted me from it but I’ve never actually seen it. According to TDI they don’t have to give it to you because they own it. My issue is they waited so long to tell me, had they told me earlier I could’ve signed up with my current employer’s insurance and they would have taken over and I’d be covered.
     
  7. hrforme

    hrforme Active Member

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    just a clarification, signing up under a new employer's STD plan would probably NOT have covered you unless you had been there are certain period of time after eligibility (Most have pre-existing conditions and some require you to be a certain time distance from your signup date). So making the claim that you would have signed up and know 100% that it would have been paid through the 2nd employer may be incorrect.

    Your only possible issue is that you were verbally told STD was portable. And honestly I've only seen it portable IF it comes through a supplemental insurance company like AFLAC or Colonial that also sells individual life/STD coverage rather than through a main employee benefit insurer (like Guardian, USAble, MetLife, etc) that sells to employer groups.
     
  8. JenG

    JenG Law Topic Starter New Member

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    I was told by the broker for my new employer that the plan would have covered me if I would have signed up within a month of my hire date. That window closed 6 days before they told me I couldn't convert.
     
  9. JenG

    JenG Law Topic Starter New Member

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    I was told by the broker for my new employer that the plan would have covered me if I would have signed up within a month of my hire date. That window closed 6 days before they told me I couldn't convert.
     
  10. army judge

    army judge Super Moderator

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    Your resolution will not be obtained on this site.

    You can speak with several, licensed attorneys in your county.

    You can see if TDI will resolve it to your satisfaction.

    You're burning time by seeking your remedy anywhere but in a court or through the TDI.

    When all is said and done you might discover all you can do is shrug your shoulders and accept things which no one can change.

    Good luck.
     
    hrforme likes this.
  11. JenG

    JenG Law Topic Starter New Member

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    I didn't come on here for a resolution, I came here for advice. I have contacted 10+ insurance attorneys and have been told that they only handle cases in which disability insurance denies a claim. I'm hoping someone can tell me what type of attorney I would need or has experience with something similar and can give me a name of one who handles this type of issue.
     
  12. ElleMD

    ElleMD Well-Known Member

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    Even if you converted it, you *may* not have been able to collect so soon. Typically, the now individual policy is actually a new policy and subject to waiting periods, etc. You aren't just picking up where you left off. It is also extremely rare for a disability plan to be able to convert but I do wonder if what your employer meant was that you would still have coverage after you left if the condition for which you became disabled fell within the period of time you were covered under the plan. That is not so unusual, particularly for LTD.

    SPDs should have been available by some means. You mention not even your employer has a copy of the policy but then say they quoted to you from the policy multiple times. It is unclear why you would have spoken with someone from the insurance company directly if this was an employer offered benefit.
     
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  13. JenG

    JenG Law Topic Starter New Member

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    So if I got pregnant while still covered under the policy, will they cover my maternity leave as if I was still covered under the policy? I know for sure they do cover a percentage of your salary for I believe 6 weeks regular delivery and 8 weeks C-section but that is if you are covered.

    I was told if I converted there would be no waiting period, but again, the company misinformed me for almost a month and a half so who knows. All the information I received was from the insurance company, my employer hadn't dealt with that before so I spoke to the company who told me what to have my employer do. The company themselves quoted from the policy in the letter they sent me stating they misinformed me but were not going to convert my policy.
     
  14. hrforme

    hrforme Active Member

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    the "sickness" or "illness" doesn't occur at tht time you became pregnant, but rather the time you become disabled -- that is when the doctor puts you on bedrest or you deliver usually. So it's the time of disability, not the time of conception that matters.

    I actually just called on this today for my employer to our insurance company and our policy does not take into account prior STD coverage with another employer (my boss wants to hire someone who has disclosed they are pregnant).

    You need to get a copy of the policy and see what it stated about correction of any mistakes, but in the end I doubt you will win and I suspect somewhere it will say that the contract/plan document will rule if there are any discrepancies in what is said.
     

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