Getting shafted by insurance company

Eaturbo · 26-10-2015, 09:28 PM

As the title says, I'm getting shafted by and insurance company. I've got income protection thru my work that covers me for 2 years if I have an illness. Now I have been off work work 11 months with and illness and about 6 weeks ago they stopped paying due to a technicality.

Now I have got further evidence to support my illness and them back paying me and continuing to pay me until I'm fit for work again and now they just want to make me a lump sum offer that only covers me up until now or for the last 6 weeks and another 2 weeks so 8 weeks in total. I have told them that based on my doctor and specialist advice that it will take until Christmas to be fit for work again. They are just trying to get away with getting me off the list and saving 2 months more payments while theres still another 12 months left on the policy if my illness continues.

What are your thought guys on this, are they just trying to pressure me into taking what sounds like a lot of money but still leaves me 2 months with no pay. Not to mention if my health worsens next year I have signed a no further liabilities document. I can't work out why on such a short 2 year policy why they are so kean to get me off the liabilities list. They have told me that they no longer supply the insurance to my work anymore and that they want to close the company policy and cut any liabilities connected to the policy. This doesn't help me any and they are bound by law to continue with the claim once opened. They can choose to just refuse to pay any more payments but I have supplied the evidence to support the ongoing payments.

Anyone had any similar experience with insurance companies, I would really like to hear your thoughts. Thanks Shane.

sgt_doofey · 26-10-2015, 09:48 PM

Check with the ombudsman on where you stand. They'll be able to give you the best advice.

Sent from my SM-G900I using Tapatalk

Eaturbo · 26-10-2015, 09:58 PM

Quote:

Originally Posted by sgt_doofey

Check with the ombudsman on where you stand. They'll be able to give you the best advice.

Sent from my SM-G900I using Tapatalk

Thanks mate, yeah that's going to be my next step along with there internal dispute option followed by there external dispute option. Always wondered why they bother with an internal dispute section. Like someone that works for them is going to go against there decision. Problems is I can't afford to be off work and not get paid which is a problem

Top_Ghia · 26-10-2015, 09:58 PM

Quote:

Originally Posted by sgt_doofey

Check with the ombudsman on where you stand. They'll be able to give you the best advice.

Sent from my SM-G900I using Tapatalk

Yep do this. It will get their attention and let them know your not mucking around. Insurance companies are dirty rotten scum bags. The simple fact is they always try and minimize or get out of paying big claims.

Eaturbo · 26-10-2015, 10:12 PM

Quote:

Originally Posted by Top_Ghia

Yep do this. It will get their attention and let them know your not mucking around. Insurance companies are dirty rotten scum bags. The simple fact is they always try and minimize or get out of paying big claims.

Yeah I know what you mean. Too me it feels like they know I can't afford to be without pay and are trying to make the lump sum look like a carrot or force me to go back to work unwell as I've got no money. Really pi$$e$ me off cause they know that with enough pressure you will go back to work sick. Problem is since my GP has certified me as not fit for work I can't even go to work cause work says well you can't come back till you got a medical clearance. Stuck in the middle of nowhere.

Ben73 · 26-10-2015, 10:23 PM

Insurance companies are not in the business of giving people in unfortunate situations money. They prefer to just take money of everyone for no reason and keep it for themselves.

As for the lump sum payment, I wouldn't take it even if you doctor says you will be good to work by Christmas. Happened to a colleague, his doctor said you will be good by x date, well that date comes and goes and he is still not able to work.
How does the no further liability part work if you said you have 12 months remaining on the policy? Will they refund that part of your premium if they refuse to offer you any more coverage.

I would have a very close look at the PDS. I had pet insurance try to weasel their way out of paying out earlier this year. They tried to claim the issue was a pre existing condition. I got the vet to write a letter stating what the issue was and what it definitely wasn't, I then started quoting clause numbers relating directly to the issue and then the insurance paid up no questions asked.
I know they are running a business, but it makes me angry when they try to get out of providing the service you pay them for.

Eaturbo · 26-10-2015, 10:44 PM

Quote:

Originally Posted by Ben73

Insurance companies are not in the business of giving people in unfortunate situations money. They prefer to just take money of everyone for no reason and keep it for themselves.

As for the lump sum payment, I wouldn't take it even if you doctor says you will be good to work by Christmas. Happened to a colleague, his doctor said you will be good by x date, well that date comes and goes and he is still not able to work.
How does the no further liability part work if you said you have 12 months remaining on the policy? Will they refund that part of your premium if they refuse to offer you any more coverage.

I would have a very close look at the PDS. I had pet insurance try to weasel their way out of paying out earlier this year. They tried to claim the issue was a pre existing condition. I got the vet to write a letter stating what the issue was and what it definitely wasn't, I then started quoting clause numbers relating directly to the issue and then the insurance paid up no questions asked.
I know they are running a business, but it makes me angry when they try to get out of providing the service you pay them for.

Thanks for your feedback mate. The policy is supplied by my work at no cost to me and covers you for a max of 2 years if your sick. My employer has swapped to a new insurance provider but as my claim was with the old provider they are trying to close off any current claims too end the outstanding liabilities. I can just refuse to accept the lump sum but I run the risk of them just saying " well tuff luck where not paying you anything than and bugger off" this than leaves you with no cover and no money hopefully forcing you back to work unwell if you can return. They than say " we'll see he went back too work so we were right" the whole thing stinks and could send some people broke.

Top_Ghia · 26-10-2015, 11:09 PM

Tell them a lump sum is a great idea. And you'll sign their agreement if they pay you out for the remainder of the 2 years.

But seriously I can't imagine this added stress is helping your recovery. Good luck with it all.

mik · 26-10-2015, 11:12 PM

Thats no good at all mate, as always these companys are all about trying to minimize their payouts and liability's , and you are just a number to them ,
indeed think about what you sign and how it would effect you if illness x recurs, you have to look after number one, that's you.

LTDHO · 27-10-2015, 07:37 AM

LOL, brilliant thread.

Assumptions about insurance do the most damage and cause the most concern.

Do yourself a favor, read the policy PDF first. Understand it, if you have any questions then discuss with your boss who will confirm anything with the underwriter or broker.

Then, discuss your options of settlement with the insurer/claims.

Eaturbo · 27-10-2015, 08:37 AM

Quote:

Originally Posted by LTDHO

LOL, brilliant thread.

Assumptions about insurance do the most damage and cause the most concern.

Do yourself a favor, read the policy PDF first. Understand it, if you have any questions then discuss with your boss who will confirm anything with the underwriter or broker.

Then, discuss your options of settlement with the insurer/claims.

Thanks for the obvious information. I'm way past reading the PDS and discussing things with the boss. The broker is supporting my claims and so is the accessor which is a third party accessor company. This is no more or less than the insurance company trying to remove all its liabilities remaining from the old policy, They have even told me so. It just annoys me that they can choose to make things hard for someone just because it suits them and there's nobody that can quickly say to them "hey that's not acceptable"

Hally · 27-10-2015, 08:44 AM

Shane,

Unless arranged via a union, I would be almost certain that your employer would use an insurer broker to place this policy. My first action would be to:

- discuss the issue with your HR team. These policies are what we term 'group' policies and your employer is the policy holder, not you. The insurer should be dealing with HR on this
- ask who the broker is. Whilst your employer may have changed insurers the broker will still have plenty of business with the insurer that is paying your claim. It sounds like the insurer is looking to back door everyone in your situation
- as someone else mentioned, do not take a lumps sum. Not worth it.
- last resort would be the ombudsman.

Cheers,

Andrew

Eaturbo · 27-10-2015, 09:23 AM

Quote:

Originally Posted by Hally

Shane,

Unless arranged via a union, I would be almost certain that your employer would use an insurer broker to place this policy. My first action would be to:

- discuss the issue with your HR team. These policies are what we term 'group' policies and your employer is the policy holder, not you. The insurer should be dealing with HR on this
- ask who the broker is. Whilst your employer may have changed insurers the broker will still have plenty of business with the insurer that is paying your claim. It sounds like the insurer is looking to back door everyone in your situation
- as someone else mentioned, do not take a lumps sum. Not worth it.
- last resort would be the ombudsman.

Cheers,

Andrew

Hi Andrew, thanks very much for your valuable feedback. Yeah the policy is a group policy. It's very strange as a friend from work has cancer and is being covered by the insurer that was before my insurer and they are not trying to remove him from the books even after 20 months. I guess they think now that 20 months into a 24 month maximum claim that it's not worth worrying about.

I have a few things I am investigating but they are using scare tactics in saying if you don't accept the lump sum and if the doctor finds something else than you might end up with nothing. They have said that they might fly me to see another specialist and if his findings are different to mine than I would be on my own.

I have said no worries send me to as many specialist as you like and when they agree with everybody else and the 30 odd tests I've had than they will be paying for the rest of the claim.

Thanks again for your help

Shane

Top_Ghia · 27-10-2015, 12:36 PM

Are they putting all this in writing? If not I would ask for it all to be put in writing.

Stefan · 27-10-2015, 12:52 PM

What a headache! I hope it turns out, money related stress is not conducive to recovering from illness.

Lesson for everyone! Take out a premium personal income insurance. Mine pays 80% of my income for life if I am unable to work because of sickness or accident. How long can you survive with no income, at the same level of expenditure you have right now? Most of us not very long at all.

We all insure our cars, boat, caravan, home etc but forget about our life or income.

**Burnout** · 27-10-2015, 12:59 PM

This is what insurance companies do. They have whole departments who's job it is to pick fight with the insured, that's you by the way.
These departments are staffed by doctors, actuaries, lawyers, space aliens, and fight pickers.
They hope you will just give up. Their plan is to push you in that direction too. So fight or give in now. Just remember "he who defends himself has a fool for a client".

LTDHO · 27-10-2015, 01:03 PM

Quote:

Originally Posted by Eaturbo

Thanks for the obvious information.

You're welcome

Quote:

Originally Posted by Eaturbo

I'm way past reading the PDS and discussing things with the boss. The broker is supporting my claims and so is the accessor which is a third party accessor company. This is no more or less than the insurance company trying to remove all its liabilities remaining from the old policy, They have even told me so. It just annoys me that they can choose to make things hard for someone just because it suits them and there's nobody that can quickly say to them "hey that's not acceptable"

No insurer can remove it's "liabilities" on any claim/policy.
I'd like to see how they put this to you.

JC · 27-10-2015, 01:11 PM

They have given you an opening offer, now it's your turn to counter offer - quadruple what they offered and go from there. Don't settle for anything less than what you should receive - from the looks of it, that's 4 months salary, which is 17 1/3 weeks pay (not 16 weeks which some may say). Settle if they pay in full, otherwise, don't.

Eaturbo · 27-10-2015, 02:16 PM

Quote:

Originally Posted by Stefan

What a headache! I hope it turns out, money related stress is not conducive to recovering from illness.

Lesson for everyone! Take out a premium personal income insurance. Mine pays 80% of my income for life if I am unable to work because of sickness or accident. How long can you survive with no income, at the same level of expenditure you have right now? Most of us not very long at all.

We all insure our cars, boat, caravan, home etc but forget about our life or income.

You know your right, we do insure everything but ourselves. Don't worry they are not going to get out of this lightly. I'm prepared to be flexible and fair but I have my boundaries when it comes too being treated fair and respectfully. Cross those boundaries and I've got a dark side that will go too the end of the earth to get what's owing to me.

Thanks everyone for your opinions as it certainly helps ease my stress and thinking.

**Cav** · 27-10-2015, 02:27 PM

Hi mate, sorry to hear about your problems with the insurance company.

The problems are more common as providers try to minimise their liabilities.

I have been an advocate for war veterans dealing with the Dept of Veterans Affairs for eight years now and what you are experiencing is no different.

May I suggest you get someone to lobby on your behalf. The reason I say this is because when you have someone acting on your behalf they simply have to deal with the issue and the company whereas you are so emotionally involved you may make a rash decision that is not in your own best interest, plus you may go and tell them o get ^&%$Y^%!!!

I dunno who you can turn to, but someone from HR may be the first try. If you are having problems with your Company's insurer then your company cannot wipe its hands of it. Imagine how it would look if employees get shafted by the insurer and your Company does nothing. This is something your Company should take a leading roll in, past insurer or not.

Place the onus onto your Company.

My advice is 'Never give up!'

Yellow_Festiva · 27-10-2015, 05:46 PM

Don't enter into any more phone conversations. Don't agree to anything unless it's written and you have referred it to another party and you are happy with it. I assume that if you agree to a lump sum that then ends your chance to have more down the track if your illness continues.

If you do make phone calls try and record them and make sure you WARN the other side that you are ALSO recording the calls. They will use your words against you at the drop of a hat, do the same to them.

Answer any questions based on fact. Don't assume anything, don't generalise, don't fall for innocent small talk that at the time seems meaningless. If they want to know about your health, pass on what the doctor has given you.

Have all your paperwork in order, know exactly what you are entitled to and seek professional help from whatever Ombudsman looks after this.

I wouldn't try to deal or negotiate with them. They are skilled in trying anything to reduce their financial exposure to you.

Start this tomorrow.. you are talking about your income and your health.

Eaturbo · 27-10-2015, 06:30 PM

Quote:

Originally Posted by Yellow_Festiva

Don't enter into any more phone conversations. Don't agree to anything unless it's written and you have referred it to another party and you are happy with it. I assume that if you agree to a lump sum that then ends your chance to have more down the track if your illness continues.

If you do make phone calls try and record them and make sure you WARN the other side that you are ALSO recording the calls. They will use your words against you at the drop of a hat, do the same to them.

Answer any questions based on fact. Don't assume anything, don't generalise, don't fall for innocent small talk that at the time seems meaningless. If they want to know about your health, pass on what the doctor has given you.

Have all your paperwork in order, know exactly what you are entitled to and seek professional help from whatever Ombudsman looks after this.

I wouldn't try to deal or negotiate with them. They are skilled in trying anything to reduce their financial exposure to you.

Start this tomorrow.. you are talking about your incomes i and your health.

Thanks guys, this is why I love asking for help here on the forums. I know it's not the answers to everything and not always right. But it helps you get a feeling for whether your on the right track or night. It annoys me that there is no standard that makes the insurance companies worry if you mention it. They just think we'll even if we have to pay later, at least we've made it hard for them and some will just walk away. There a bunch of ****** if you ask me, and income protection policies are the worst area of all insurance.

Yellow_Festiva · 27-10-2015, 06:37 PM

Quote:

Originally Posted by Eaturbo

, and income protection policies are the worst area of all insurance.

I'm dying for the travel insurance industry to be investigated / better regulated. They are shonks as well. The one time I ever made a claim ($300 claim on a $900 policy mind you!) they dragged it out for several MONTHS even though they advertised they process claims in 7 days...

Good luck with it mate, hope it goes your way!

**GasoLane** · 27-10-2015, 06:53 PM

Quote:

Originally Posted by Yellow_Festiva

I'm dying for the travel insurance industry to be investigated / better regulated. They are shonks as well. The one time I ever made a claim ($300 claim on a $900 policy mind you!) they dragged it out for several MONTHS even though they advertised they process claims in 7 days...

Slightly of topic but I claimed on my domestic travel insurance last year. 1Cover, about $500 and had the payout in a week.

So I'll be using them again next week.

Yellow_Festiva · 27-10-2015, 06:56 PM

Quote:

Originally Posted by GasOLane

Slightly of topic but I claimed on my domestic travel insurance last year. 1Cover, about $500 and had the payout in a week.

So I'll be using them again next week.

They are the mob that shafted me

irvinnie · 27-10-2015, 07:20 PM

Quote:

Originally Posted by GasOLane

Slightly of topic but I claimed on my domestic travel insurance last year. 1Cover, about $500 and had the payout in a week.

So I'll be using them again next week.

Trying to claim a stolen iPhone through budget direct at the moment on our travel insurance. Every week we call and get told to ring back in another week. It feels like they are just hoping we stop calling.

Eaturbo · 27-10-2015, 08:29 PM

I would like to see the insurance industry more heavily regulated. As far as I'm concerned they should not be allowed to make insurance policies that are misleading and have exclusions that contradict what the policy is offering. Also they should not be allowed to make decisions that go against specialists recommendation and disregard the facts. It's like with car insurance when they don't want to replace car parts that could have sustainined damage in an accident. How can they make decisions on a cars safety without any experience or without testing the part In question. They seam to be a law to themselves with no accountability unless you really push them.

I put insurance companies in the lowest class of integrity business and ethics. They also seam to be able to pick those who are easy targets or of a soft nature.

LTDHO · 27-10-2015, 08:55 PM

Quote:

Originally Posted by Eaturbo

Thanks guys, this is why I love asking for help here on the forums.

If you are after misguided information.

Quote:

Originally Posted by Eaturbo

It annoys me that there is no standard that makes the insurance companies worry if you mention it. They just think we'll even if we have to pay later, at least we've made it hard for them and some will just walk away. There a bunch of ****** if you ask me, and income protection policies are the worst area of all insurance.

Quote:

Originally Posted by Eaturbo

I would like to see the insurance industry more heavily regulated. As far as I'm concerned they should not be allowed to make insurance policies that are misleading and have exclusions that contradict what the policy is offering. Also they should not be allowed to make decisions that go against specialists recommendation and disregard the facts. It's like with car insurance when they don't want to replace car parts that could have sustainined damage in an accident. How can they make decisions on a cars safety without any experience or without testing the part In question. They seam to be a law to themselves with no accountability unless you really push them.

I put insurance companies in the lowest class of integrity business and ethics. They also seam to be able to pick those who are easy targets or of a soft nature.

You are kidding right? Insurers are the most governed business around, you simple don't understand so you class them as being misleading and contradictory.

You have an option of self insurance if you don't like the policies offered to you. Let me know how that goes!!!

You have no idea, and don't want to by the sound of it.
I'm out! Best of luck mate!

MITCHAY · 27-10-2015, 09:31 PM

If you having issues with this insurance company it might be worthwhile checking if your super fund has income protection insurance included. I'm not sure if you can draw down on both though I figure if you're employer is paying for one and the other comes from fees then why not.

As a last resort if you are having issues with insurance paying up you may be able to access your a portion of your super to get you by.

https://www.ato.gov.au/individuals/s...to-your-super/

There are obviously strict rules for this and it is not ideal as it is meant to be for retirement and can cost you loss earnings as well as it being taxed.

Autolite · 30-10-2015, 10:08 PM

Quote:

Originally Posted by Stefan

What a headache! I hope it turns out, money related stress is not conducive to recovering from illness.

Lesson for everyone! Take out a premium personal income insurance. Mine pays 80% of my income for life if I am unable to work because of sickness or accident. How long can you survive with no income, at the same level of expenditure you have right now? Most of us not very long at all.

We all insure our cars, boat, caravan, home etc but forget about our life or income.

Hey mate what company are you with? I'm looking for Income insurance atm and have not come across Insurance for life, the max I have found is 2 years.

Regards
Pete