Like most responsible people, through my employer I purchased numerous products to insure me and my family’s future in case I was the victim of an untimely death, sickness, or injury, most through American Fidelity Assurance Company. I had life insurance, cancer insurance, and short and long-term disability policies. On examination of their products as explained by their representative, all appeared to be sound and reasonably priced, so I opted to buy the maximum amount of protection to make sure I wouldn’t be at the mercy of Social Security insurance – and even helped the salesman to sell his policies to other members of our company. Quite frankly, I was impressed with the diversity and price of their products as represented by their agent and enthusiastically helped to spread the word among my co-workers that these “seemed” to be great products, as I had been injured several years earlier and learned the value of having additional protection in case of an emergency. I also had Blue-Cross Blue-Shield Health insurance.
Unfortunately, a few months later, I was the victim of an illness and accident; the illness which was suspected to be the proximate cause of the accident. My Doctor was convinced I had cancer (Multiple Myeloma), as I had lost almost thirty pounds in the previous months, and while showering and getting ready for work, I became faint and fell in the tub – breaking one of my lumbar vertebrae(s). My physician was so convinced that I had cancer that the back injury was placed on the back burner, and she stated the most important matter was to keep me alive. My weight had dropped from 180 Lbs when I arrived in Kansas to 144 lbs by the time I left the state, and when I left I was thoroughly convinced I would soon pass away. Weighing 144 lbs, I looked like death eating a soda-cracker – and felt even worse.
I applied for short-term disability through American Fidelity, thankful I had the salary protection so I could still pay my rent, buy food, medicine, and pay my health insurance premiums. From the very start, the problems began with American Fidelity Assurance Company; I lived in a very small town and hadn’t been seen by a doctor prior to the injury/illness for approximately two years. In spite of that, American Fidelity insisted on running a “pre-existing injury/illness investigation” and refused to pay any benefits until the investigation was completed. My rent was overdue, we were having a hard time feeding ourselves, and my health insurance premiums became dangerously overdue. I understood they had a right to instigate such an investigation, however, due to the seriousness of my condition, and the possibility of losing my health insurance, I called them several times essentially begging them to release my benefits. I had already signed a statement that indicated I would be guilty of fraud if I had a non-disclosed pre-existing condition(s) – so to me, being the customer and essentially fighting for my life, it seemed reasonable to give me the benefit of the doubt and start my compensation. Needless to say, my appeals to their staff were in vain, and by the time I received my first compensation payment, it was too late to salvage my health insurance.
At this time, it’s important to note that since then, I have related these facts to several attorneys and was informed by each and every one of them that this is standard practice with most disability insurance companies! If you lose your health insurance the probability of death or even having the ability to prove you’re disabled becomes extremely hard, so disability companies use this practice as a matter of procedure in an attempt to lower their financial exposure and if they can, to discontinue your policy.
It’s also important to note that In Kansas, even though I was awarded a Medicaid Card, the state offers no prescription assistance to singe adult males without minor children, and Doctors, Pharmacies and Hospitals only will treat you if they agree to defer their compensation until you win Social Security benefits. The facilities I found to honor my Kansas Medicaid Card were zero. (I guess that’s more of that “compassionate conservatism” that Kansas Republicans boast about!
Further, I was living with my girlfriend, a young college student, and we found ourselves to be under surveillance from a private investigator – which did little to hide his presence or even appear to be stealthy, which scared the crap out of my girlfriend, not knowing who he was. I finally caught him unexpectedly, made him call the local police department, and he was promptly asked to leave the town because he failed to make his presence known to the local police, which is more or less a matter of protocol and respect for the local police force. So, besides losing my health insurance, we were also harassed by a private investigator – which caused immeasurable stress and apprehension. No one that is seriously ill deserves that kind of treatment, and adding stress to an already diagnosed case of clinical depression does little to help one cope with a serious accident/illness.
I left Kansas in January of 2005, gave away almost everything I owned, and left a wonderful life with an exceptional woman and friends, convinced I was on my deathbed, and so depressed and ill that I was barely able to care for myself, including the ability to reason-out issues and problems and form cognizant thoughts. In short, I was a mess and lived in a reality I was unable to understand. It appeared I had lost my mind â€“ and quite frankly, I was quite unrecognizable mentally or even physically to most of those that had known me.
When I arrived in Pensacola, Fl., I was essentially bedridden for the first two months I was home. I had entered a period that was now long-term disability, and much to my surprise, my monthly compensation rose from the $1,200.00 a month I received in Kansas to $1,800.00 per month, which was quite a surprise! I called American Fidelity and asked them why my benefits had increased, and was told that under the long-term policy my benefits automatically increased to the maximum amount I had purchased when I bought the policy. My benefits were being awarded to me contingent that I repay the company any â€œoverpaymentâ€ I might receive, and this was explained to me as money that I would receive from Social Security if I won my case, which was an â€œoff-setâ€ to my policy. It seemed reasonable to me, as I was happy to have enough money to live on and be able to receive much needed medical treatment and medication. Besides, they did explain to me that any Social Security back-payment I might receive would have to be paid back to American Fidelity. I signed the agreement, as it seemed perfectly fair to me.
I went though the lengthy Social Security appeal process, and finally last month, my benefits were granted and I was awarded Social Security Disability while appearing in front of a Federal Law Judge. Prior to the hearing, I contacted American Fidelity Assurance Company and asked the adjuster what would happen if I won my Social Security Appeal. I was advised that whatever the amount of my monthly benefit came out to be, that amount would be subtracted from the $1,800.00 a month I currently received and I would then be responsible for repaying American Fidelity any â€œoverpaymentâ€ I had received from Social Security. In effect, I would receive my monthly Social Security check and American Fidelity would make up the difference so that it would equal a total of $1,800.00 per month. Again, it sounded fair to me, so I aggressively pursued my Social Security appeal, and because of the preponderance of evidence, won with a â€œBench Decision.â€
As per my agreement with American Fidelity, I immediately forwarded them a copy of the â€œAward Letterâ€ I received from Social Security, and when I called to ask a question, found that my adjuster had been changed. I asked her several questions and she informed me that the adjuster that informed me I would be receiving the difference between my SS payment and the $1,800.00 per month was wrong, that she was unaware of certain â€œclausesâ€ in my policy. I asked her what she meant, and she stated that my policy would revert to the original amount of $1,200.00 per month, leaving me with a benefit of approximately $450.00 per month plus my Social Security check.
I canâ€™t say I was pleased, but in light of the â€œgapâ€ in Medicare coverage, at least at $1,200.00 per month I would qualify for certain programs that would protect me from the Medicare â€œgapâ€ clause, so I begrudgingly agreed and asked her to send me the breakdown so I could finish my Medicare paperwork. Last night I downloaded AFACâ€™s breakdown â€“and to say I was astonished is an understatement! My part of the Social Security back-payment is approximately $13,900.00. American Fidelity Assurance Company states that I owe them $26,531.20! In other words, after I pay them any back-payment from Social Security, I still owe them another $12,631.00. The raise that was given to me when I reached long-term disability, even though I didnâ€™t ask for it, and which I questioned â€“ has to be paid back before I receive any further benefits. No one explained this to me, I called-in and questioned why I was receiving a â€œraiseâ€ in the first place, and I was told it was a benefit of the long-term policy. In other words â€“ my long-term disability policy is now defunct. (A copy of their breakdown is provided for your perusal in this article.)
I have written this lengthy article in the hopes that it will bring awareness to people who purchase short and long-term disability policies. At every juncture, I have questioned adjusters at American Fidelity Assurance Company to make sure I was aware of my policy and any limitations that might arise. In fact, when I bought the policy, the salesman told me its duration was until the age of 65, however when I received the policy, it stated the age of 60. He referred me to another section of the policy that indicated if you were under 56 or 57 years old, the policy would last until you were 65, thereby satisfying me that it would last until I was 65. Now I am told it will only last until I am 60, that is, after I pay them over $26,000.00. (sic)
There are lessons to be learned here. Never listen to a word an insurance adjuster tells you! Even if you think you understand your policy, have an attorney look it over. AFAC states the adjusters didnâ€™t lie to me, they were simply â€œuninformedâ€ of certain clauses within my policy. I call it a lie, they call it a misunderstandingâ€¦ (Maybe they should all be working in the White House…)
Read their letter closely. Consider everything you have read herein, and their letter, and ask yourself if this is really a long-term disability policy â€“ or a sham and a very clear misrepresentation of what a real disability policy should be. Obviously I am quite angry, but rather than me being the judge, you read the facts and you make the decision. Is American Fidelity Assurance Company a business that you would trust your future to?
Is that what a normal person would consider to be a valid long-tern disability plan?
As for me, I believe they are charlatans and con-artists, and I feel cheated and I believe their conduct borders on misrepresentation and fraud, however that is my personal opinion. Obviously this will be a matter for the courts to decide, but until then, I have written this article as a warning to anyone that believes their future is secure in the event of a serious injury/illness that has a disability policy with this company. Donâ€™t take my word for it, have an attorney examine your policy, for your protection, please donâ€™t listen to any of their adjusters! It is possible that not one, but several adjusters made mistakes when describing my benefits to me, but itâ€™s also possible they hid the truth, thereby becoming the Grinch that stole this yearâ€™s Christmas from my family, as well as my retirement. Donâ€™t let it happen to you! Find a reputable company to secure your future, and in my honest opinion, AFAC is not that company.
Note: You can read this letter by following the below link to www.Liberalsonly.com .
Note:There is also a thread running on this at The Smirking Chimp which you may want to check out. Michael Moore is starting a new documentary entitled “Sicko” which will expose some of the many practices of the health insurance industry, and many of the dirty tricks they pull as they attempt to screw the public through the many dirty tricks and “clauses” contained in many of their policies. I have sent in my story, and I recommend you do the same if you know anyone that has suffered at the hands of health care providers or disability companies as they routinely attempt to lower their exposure by misrepresentation and “fine print” contained in their policies.
It’s about time, and the letter from Michael Moore is displayed on that thread.