Dallas, TXWhen people have insurance policies or guarantees they will be taken care of in the case of an insurance or disability claim, they tend to believe that those who promise to take care of them will act in good faith. But claims are often made about insurance companies and organizations that are meant to provide disability insurance acting in bad faith, by wrongly delaying or denying disability claims. Included in the groups that are reportedly fighting to ensure their legitimate claims are properly processed are veterans and people in California seeking occupational or speech therapy.
CBS DFW (Dallas/Fort Worth; 11/22/13) reports that thanks to having disability benefits denied and an extremely lengthy appeals process, some veterans are dying from the illness responsible for their claims before their claims are approved, leaving the veterans’ spouses and/or children to continue fighting for benefits. The report highlights the case of one veteran who was exposed to Agent Orange and had more than 40 surgeries to remove tumors and fight other conditions that he claimed were the result of his exposure to Agent Orange.
The veteran died in 1991, before his claim was approved, and his wife continued the fight, still being denied more than six times before her claim was approved in December 2012. CBS said it uncovered approximately 150 cases from North Texas alone in which the veteran died during the claims process, resulting in the claim being denied or dismissed.
Meanwhile, in California, insured people - including children - seeking speech and occupational therapy have reportedly had their claims delayed or denied by some insurance companies that do not see speech or occupational therapy as medically necessary. The situation caused enough concern that California’s Department of Managed Health Care ordered the three companies - Health Net, Anthem Blue Cross, and Blue Shield - to stop denying medically necessary therapies. Health Net was also handed a $300,000 fine.
An independent review found that of 36 cases that resulted in a denied disability complaint against Health Net, all but one involved medically necessary speech and occupational therapy. Meanwhile, of 24 cases that resulted in a complaint against Anthem Blue Cross, all 24 were deemed in an independent medical review to be medically necessary. According to reports, many of those denied treatment were children.
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