I signed up for a supplemental insurance plan thru my work with a 3rd party in march of 2023. In August i was diagnosed with bone on bone arthritis in my shoulder. Ive had shoulder injuries before of a torn labrum. I did have stem cells and prp on that and believed it was healed as during my shoulder replacement my surgeon reported my labrum was intact. The insurance company states you have to be a member for a year for pre existing injuries which is fine as Ive never had a diagnosis of arthritis. So I had surgery in Nov and submitted my claim which would be about 4 months out of work at 3500 a month in payments. Well because it was less than a year theyve request all my doctors so they can get the medical records. I submitted all my doctors information and signed whatever release forms they require. So its been months and they keep saying 2 of my doctors, my primary care and another specialist ive seen for things like sleep apnea and a mass removal from my back. Everything related to my shoulder has been submitted but they refuse to do anything until these 2 records are received. Ive called both and they say they try to get the records to my adjuster but no one ever gets back to them. I was able to obtain them the very next day but they cant take them from me. What resources do i have to force the payment or at least force them to finish the claim?

    Injury insurance payout taking months
    byu/dtacobandit inInsurance



    Posted by dtacobandit

    1 Comment

    1. LeadershipLevel6900 on

      What does the provider need from the adjuster? The adjuster’s request would have the claim number and the info on where to send the records, so I’m not sure why they’re waiting to hear back from the adjuster for anything.

      The insurance company has a right to investigate their claim, you can’t force the issue, especially given the prior history.

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