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Wrongfully denied Short Term Disability coverage by Aflac Pennsylvania

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  • Wrongfully denied Short Term Disability coverage by Aflac Pennsylvania

    So, I applied for STD coverage from AFLAC through our small business. I had recently experienced a cornual ectopic pregnancy and miscarried. I fully explained this on the application. There should have been no reason to deny me coverage as I was told by my doctors that the situation should have no bearing on any future pregnancies. I received a letter saying that I was denied coverage. I wrote a letter asking why, as they would not tell me unless I asked in writing. They wrote me back saying the following, "applicants with complications due to pregnancy are ineligible for coverage. We will be glad to reconsider you for coverage upon completion of the pregnancy."

    This wording leads me to believe that they think I am still pregnant and am having a complicated pregnancy. I have called them numerous times and am always told the same thing. I need to have all correspondence in writing and I cannot speak to anyone physically. I am getting very aggitated that no one will respond to my calls. I feel that I was wrongfully denied coverage and need to know if I should contact an attorney.

    Any advice would be appreciated. Thanks!

  • #2
    This isn't what it means at all. It means that your medical situation didn't disable you per the definition of the policy. Most conditions related to pregnancy aren't covered as they are not disabling. Giving birth is considered to be so. Miscarriage early on generally does not render one disabled, though it is understandable that you would want some time off work for personal reasons.

    If in your case you truly were disabled for a time as aresult, you should file an appeal through whatever procedures are laid out in the plan documents. The denial letter probably included this information as well. This almost never requires a lawyer.
    I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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    • #3
      I think you misunderstood my post. I didn't try to collect on my STD. I was applying for coverage for it. We were trying to implement a plan at our business and we needed 3 employees to take part. They denied me coverage. I was not trying to put in a claim. Sorry for the confusion.

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      • #4
        Have you responded in writing to clarify the situation as requested? There should also be an appeal process for denied coverage. Again, this rarely requires the services of a lawyer.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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        • #5
          yes, i've sent two written letters and have still not heard back yet. each time i call they tell me i can't speak to someone. without verbally speaking to them, i'm afraid the situation will not be clarified. they clearly misunderstood the application and have denied me for something that is not even the case. i just want to speak to someone on the phone.

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