9 Aug, 2021 → by ClaimboUser311398
Aflac refusing to pay/Contract Issues/Wrongful Claim Resolution
2
I took the policy because my husband did home repairs for a living. Back in January 2020 My husband got injured and became paralyzed and has been in a wheelchair ever since. Back in April 5, 2021 my husband fell out of his wheelchair and had neck surgery while the policy was in effect. Now after months of run around Aflac doesn't want to pay the claim. I sent Aflac every single document that they ask for just as I had done with the previous claims. His doctors in the billing department are fully aware of me obtaining information from his records that our insurance companies ask for. In the past they've paid out our claims to us they've obtain all documentation related to the injury. Just recently Aflac has been putting us off by allowing the claim to exceed past 28 days by waiting that long for it to be in review so they can close out and deny it. (It's been over 4 weeks and the claim is still in review.) and for some reason they've been demanding that we sign over authorization to obtain my husband's records. My attorneys have advised against this because there are open court case legal proceedings with additional parties involved regarding my husbands accident in his medical records that does not pertain to Aflac whatsoever. I uploaded multiple letters to Aflac when I filed the claim with these concerns that Aflac is already been notified of because the concern is that they are illegally requesting that you sign over authorization to disclose his medical history which is an extreme violation of HIPPA under this new condition. Aflac will not respond to me with what additional medical documents they need but yet they want to keep denying the claim instead of paying it out?? JUST because we won't sign that form that I'm not comfortable signing? Also Keep in mind Aflac has already paid for my husbands hospital stays in the past without any issue even though it's been difficult going back and forth with the hospital's billing department to get the documents that Aflac needed. It is so unethical for a company to solicit a business, offer coverage, acccept premiums, then when a claim is filed, imply to the policy holder that they HAVE to have THEIR signed authorization form from the policy holder or the claim won't get paid. Honor policy holder's accident coverages in the contract and pay their claims! Ask for more documentation of treatment if that's needed. Request more information in his records RELATED TO AFLAC if that's what's needed. It is illegal to refuse to pay a claim to a policy holder and retaliate against the policy holder just because they are refusing to sign over their medical records. You guys have NEVER ASKED ME TO DO THIS IN THE PAST? What's changed? My husband and I have every right to protect our privacy under HIPPA. Attached is the accident policy benefits due showing proof of the benefits my husband is eligible for, highlighted items of what's specifically listed in the policy of the benefits that Aflac is supposed to pay out to us, screen shots of Aflac wrongfully advertising their products and services on social media (which in my opinion shows that I've been deceived because Aflac does not do what they actually advertised), the facts of what Aflac stated in our contract agreement of what they do with our personal information, and me exercising my rights under HIPPA to refuse to sign that authorization form that they requested based on those conditions. Here's to a long miserable road to recovering compensation for my injuries.