by dbpmnn » Thu Oct 21, 2010 08:45 pm
my mother died in a two vehicle car accident-the other vehicle said she was in their shoulder lane(not hers), so they swerved into her lane to avoid her, but yet somehow they collided with her head-on into her drivers side front door completely in her lane and it flipped her vehicle and she died because she was wearing her seatbelt and it partially ejected her and her vehicle landed on top of her killing her. The crash report said after they swerved she regained control of her car and got back in her lane --this story does not make sense and no one has seemed to notice this??? She had Cigna life insurance and accidental death and dismemberment insurance but Cigna is denying the policy because she had sleep apnea and they are saying she likely fell asleep while driving because of this and therefore her death is not an accident--I do not understand how this is not a covered accident --any advice? I wrote an appeal letter and they have said the are reviewing the appeal and said they are in the process of obtaining the sleep apnea report (which they never even contacted or tried to get for the claim) from the sleep testing study she was driving directly from the morning she was killed--and I called the sleep testing study today and they said they have not heard from or received anything from Cigna--Cigna's letter stated they were in the process of obtaining this report over 2 weeks ago but I have found out they infact have not done so--I feel this a legal violation to tell me they did something when infact they are lying and they have not and this is one of the main determining factors of this claim???
Posted: Thu Oct 21, 2010 08:51 pm Post Subject:
she likely fell asleep while driving because of this
"Likely"? They would need to have enough proof to convince 5-7 people sitting on a jury that this _did_ happen... not that it _might_ have happened.I feel this a legal violation to tell me they did something when infact they are lying and they have not and this is one of the main determining factors of this claim???
Called Cigna and confirm the date on the letter they sent requesting this information. See if Cigna will send you a copy of the letter. If they won't tell you the date and/or send you a copy then this is a good indication that it was not sent.Can you obtain a copy of the report and sent it to Cigna?
Posted: Thu Oct 21, 2010 09:02 pm Post Subject: getting the report
Yes my sister and are in the process of getting the report -- there ofcourse are forms we have to send to the sleep testing study which the woman is calling us tomorrow to tell us everything we meed to do and send.--I have the letter from cigna which stated they were in the process of obtaing the report--but when I spoke with the woman at the sleep study today, she confirmed they had no record of any request or any release of these documents to Cigna or anyone else.--Tomorrow i am sending an email to her to get proof of the date and time confirming there has been no request made by Cigna--We called the sleep study on our own because we wanted to know if and when the documents were sent--we were not expecting them to say they had no record for any request. They have not sent any letters to my sister who is the other beneficiary since we sent our appeal letter--they have always sent us both identical letters throughout this ordeal--don't they have to send her letters--if not, don't they violate the insurance laws?
Posted: Thu Oct 21, 2010 09:20 pm Post Subject:
Posted: Thu Oct 21, 2010 09:25 pm Post Subject:
but when I spoke with the woman at the sleep study today, she confirmed they had no record of any request or any release of these documents to Cigna or anyone else
I understand your frustration but I'd also say that 2 weeks is not completely unreasonable. Depending on the medical facility, the letter might have been sent to one address and it then needs to be moved to the correct location for the records to be copied and sent out. To me is sounds like you are doubting that Cigna sent a letter. This is why I suggest asking the adjuster for the date on the letter and a copy of it. It's easy to lie about sending the letter... it's more difficult to lie about something that can be verified.don't they have to send her letters--if not, don't they violate the insurance laws?
Perhaps... it's tough to tell with limited info. But I think you are jumping way ahead. You are really asking if you can file suit against the insurance company for their current actions. Well, filing a bad faith suit is not easy. There is a _lot_ of work involved and it can take years to see it through. Do you really want to do all of that right now? I'm looking at the path of least resistance.Posted: Thu Oct 21, 2010 09:48 pm Post Subject: Its been a year and 19 days
After they denied the claim--which took them 10 months to do--We requested the entire file--and in April, we requested the autopsy report in writting in an email--which we never received until we requested it again after they denied the claim--the claims specialist said he must have over looked that part of the email-- the medical examiners report on cause of death was accident by severe motor vehicle injuries --it listed no contributing factors and no underlying conditions other than the severe motor vehicle injuries--is the medical examiner the decider or what caused her death?? And in my appeal letter, I stated that my sister and I were seeking out a professional to interprete the autopsy report and findings so that we could comprehend what it means because it is 7 pages of medical terms that we don't understand because we are not in the medical field--since the first after appeal letter I received another letter telling me that I am to send them a copy of my professional's report explaining the autopsy by Nov 11, 2010--which is in like 20 days-- because they have to have this so that they can determine how it relates to the policy--?? Its a very intimidating and offensive letter--which the only reason we said we were "seeking out" a professional was so that we know what my moms injuries really were--i don't know what a crushed chest cavity means or a lacerated spinal cord or an avulsed whatever even means--we never got to see my moms body because the funeral guy said it was a liability--we then said can we see her hand or toe so we have a small bit of closure and after he viewed the body he still insisted that we didn't--her body was extremely bad--so naturally all we have is the autopsy and we want to know what it says--I don't know why they need our interpreter to write a report--they have a medical director?? Plus they have already reviewed it--they even had an independent review on which took an extra 4 months in their claims decision the first time--???
Posted: Thu Oct 21, 2010 09:56 pm Post Subject: little more info
Oh I just got this letter yesterday --so I have 21 days to get this too them--but I don't understand why??
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