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Aetna is another one of the large publicly traded insurance companies which sells disability insurance. Of the approximately 34 billion dollars a year of revenues collected by Aetna, disability insurance is less than 10 percent of their business. Aetna is one of the top ten largest disability insurance companies in the nation.
From our experience of handling numerous Aetna disability claim denials and lawsuits, we find Aetna to be disorganized with regard to the handling of their disability insurance claims. In some cases, Aetna disability claim managers work from either their homes or remote office locations in which no other Aetna employees are present.
We welcome you to watch our Aetna Disability Video featuring Attorney Gregory Dell and Stephen Jessup.
Most Aetna Disability Claims Are Governed By ERISA
Our disability lawyers have been successful in assisting hundreds of Aetna disability claimants to receive payment of their disability benefits following either the submission of an ERISA appeal or the prosecution of a lawsuit. Since Aetna sells only group disability coverage to employers, the policies are usually governed by ERISA.
If you would like more information about ERISA, we recommend you watch our numerous videos discussing ERISA disability claims.
Our disability lawyers are available to handle Aetna Lawsuits in any federal court nationwide.
Our Disability Lawyers Keep Their Eyes on Aetna Every Day
We have a tracking system that allows our lawyers to receive a notification anytime either a lawsuit is filed against Aetna or a court renders a decision regarding an Aetna disability denial.
As a free resource to help Aetna disability claimants we post summaries on a weekly basis about the recent lawsuits or court decisions against Aetna. We believe that if a claimant understands how Aetna behaves, then they will be in a better position to avoid a claim denial.
In addition, we invite Aetna claimants to post comments and/or complaints on our website about their experience with Aetna.
Whether you are considering applying for benefits, waiting for a claims decision, or have been denied, we are available to assist your with your Aetna disability claim anywhere in the country.
There are 164 opinions so far. Add your comment or complaint now.Robert Samia:
Sir, I had insurance with BlueCross Blue Sheild for fifteen years, no problems. I was laid off April of ’09 with continued coverage through Cobra. I was told by an agent that Aetna offered similar coverage to what I had. Three months into the policy my wife, a personal trainer, had a heart attack. I drove her to the hospital, the doctor called for a helicopter and she was medivaced to another hospital and, thank god, she is ok. Since then Aetna has refused to pay for almost everything, giving every excuse in the book. She also has prescriptions they won’t copay, plasic two hundred dollars a month, they say they will only pay for generic. You get the picture. I would like to find another insurance company and sue Aetna for false advertising.Ellen Kivler:
I have or should i say had, Aetna short and long term disability insurance. This company is a total ripoff. They are really good at collecting premiums, but God help you if you need them to pay off. Good luck getting them to return calls, you my as well call the moon, you would have better luck hearing from one of the rocks up there, than from this company.Marlene Long:
I was placed on short term disability last year for about 3 months after a car accident and my STD insurance company Aetna paid me for the 3 months I was on leave. I returned back to work and began having issues again and changed doctors as my prior doctors did not know how to treat me. I was sent to a chiropracter who was treating me. He placed me on STD leave in Feb, 2011 for 2 weeks and 2 days thinking this would help my condition. Upon his evaluation after the leave, I was only allowed to return to work on a part time basis. He also sent me to a Neurologist who ended up diagnosing me with Fibromyalgia. The chiropracter advised that he believed that I had other issues with my back. Aetna paid me part-time until April 1, when I was placed on full-time disability leave. They denied my claim and upon appeal, sent my case to a Rheumatologist to evaulate. Please note Aetna is also my medical insurance company. These doctors did not make my primary care doctor aware of all of this as they told me they were. Upon advise of a friend, I spoke with both doctors about seeing a rheumatologist and they said it wouldn’t hurt. While waiting for appointment to see rheumatologist, Aetna denied my appeal. I have since seen my primary care doctor who advised that both doctors should have sent me to a rheumatologist once the Fibromyalgia was diagnosed. I have since seen the rheumatologist who confirmed that I do indeed have Fibromyalgia. He has ordered further testing and suspects that I might possibly have Spondloaropathy. I only have the MRI left to do. He has also diagnosed me with restless leg syndrome and per a sleep study results, I have sleep apnea. I have applied for Social Security Disability and am waiting for an answer. However in the meantime, I have no income coming in. How do I proceed about Aetna STD and their denial of my claim considering my current diagnosis?Attorney Greg Dell:
If you have exhausted all of your ERISA appeals, then you have the option to file a lawsuit against Aetna at this time. In order to determine if we could assist you we would need to review your denial letter and a copy of your Aetna Disability Policy.Darounsaville:
Resubmit, resubmit over and over again. Ask for further review, preferably with a bit of new medical info. It should be in your policy book. Appeal over and over again. Each time it is supposed to go to someone above who originally denied the claim. You can write to the insurance commissioner in your state and complain, and you can write to your state legislators and federal ones too. They are usually pretty fast at answering these letters.Gene Lechien:
I am on long term disability which Aetna handles. My IME said that I will be reevaluated in Dec. 2012. The policy says something about covering me if I can’t find a job that is at least 70% of my work pay. What does that mean? I don’t think I can find a job after my stroke that will pay me that. I’m worried that in Dec. they will deny me. What should I do?Attorney Greg Dell:
You need to continue treating with your doctors and documenting your medical conditions that prevent you from working. The 70% of your work pay, means that if you made $100,000 a year pre-disability, then Aetna must make a determination that you can work at a job that will pay you at least $70,000 a year. Aetna will likely hire a vocational expert to perform a Labor Market Analysis and Transferable Skills Analysis. We regularly advise clients on a monthly basis about how their claims should be handled in order to protect your monthly benefits. If you contact us and send us your policy we can arrange a free phone consultation to discuss some of your options.Arlene:
I am currently on LTD for what has just been diagnosed as a Vasculitis condition. It is a rare autoimmune disorder. I have been paid by Aetna in LTD since 1/11 and now Aetna, my insurance company, has had me followed for more than a month. The other day I was so freaked out by this guy following me and I almost turned into oncoming traffic. They have been following me consistently for more than 1 month – what should I do? They have not denied me. How much do I take before complaining to someone? I could have been seriously hurt. I have 3 physicians who have me off work and all medical records, yet they are continuing to harass me. I paid into this insurance plan myself, don’t I have rights? It is just incredibly stressful and I don’t know what to do.Attorney Greg Dell:
If you feel that you are being followed and your life is in danger, then you should immediately report any incident to the police. You can get the police to call Aetna and verify whether you are being watched. In order to protect your benefits you need to continue treating with your doctors and make sure your restrictions and limitations are well documented by your doctors. If you would like assistance with you claim then feel free to contact us to discuss your options. You may also find our videos discussing video surveillance helpful.I Can't Stand Aetna:
I have yet to receive a denial letter of my claim with Aetna. Aetna is the administrator for my company’s disability benefits. I do work for a Fortune 500 company. I have never been on any type of leave during my long tenure with my company. I find it very disheartening with the way they treat people. I have since been hospitalized twice in the last two months, and have been off for 8 weeks exactly. My primary care physician has had me off since and continues to have me off due to my inability to function at a 100%. My doctor and I have sent and responded to all of their requests for medical information and my case manager who is very difficult and lacks for customer service skills and sensitivity to people and their needs.
The case manager states that they can not find any reason as to why I can’t work. Now, there are two separate issues.
1) For the chest pains that are consistently strong through out the day, the doctor has prescribed medication after medication and have yet to take care of the problem. My doctor is at lost for words as to what’s going on, now there are different side effects from these different medications that’s been prescribed for me. Again, it knocks me out to where I am in bed all day. This is not normal especially when the medication is to be taken in the morning with my diabetic medication. I also have nerve medicine to take in the evening to help with the damaged nerve on my left arm.
2) The second issue is that I have tumors in both of my knees, which also disables me from walking without assistance. The bone doctor had to hold off on any treatment for this until the chest pains were ruled out that they were not heart related issues. Now, he just started therapy and my knee swelled up and after the 2nd day of therapy my therapist decided to call it off until I return to my bone doctor. I was down, not able to walk at all on my left leg, the swelling went all the way down to my ankle and foot. Again, my case manager said that was not good enough, all because I can’t stay awake from the side effects of the medication and me not being able to walk, it should not disable me from working. First of all, I can’t wear flip flops to work, secondly, me not being able to walk without pain I really couldn’t believe this lady.
I spoke with several other managers and they have advised me to take it up with our HR department which I did. I also took it a step further and advised our plan administrator in regards to this. Meanwhile, I have not been paid for over a month, bills are still coming in. Also every time Aetna contacts my doctors for certifications there is a charge ranging from $25-$30 every time and I’m stuck with the bill and they still fail to pay me. I was also advised to seek legal counsel which I am going to do since there is no one is trying to assist.
If this is the kind of partner that my company uses and we speak about people being first, we’re not walking the talk.Tim l. Price:
I worked for a company called Avery Dennison. I had Aetna insurance for 15 years. I needed neck surgery which they paid for. They were aware I needed a second surgery. They refused to pay for the second surgery. I had bulging discs in my neck with a bone that was growing around my spinal column. I couldn’t feel my legs. Christopher Furey, head neck and spine Doctor, also a Professor of Medicine, said I needed this surgery urgently. I submitted my MRI with doctor’s notes and was denied. As a direct result of that, I couldn’t get the surgery done. I lost my job, house, car. Displaced two days before Christmas. I have permanent nerve damage in my neck and arms. Pain (awful). What they did was ruin my life. Help me. If there is mercy on this planet I beg of you to point me in a direction. I have a child. My wife and I divorced after 21 years together. Her back was injured. She couldn’t get treatment, because I lost my insurance. Her life is ruined. They should be held accountable for their mistakes. I have all MRIs on disc. All doctor’s notes on surgeries. I need an attorney. I’m also a diabetic. I have read the comments of the people above. OMG!!! DENY-DELAY-DEFEND. I am horrified!!!Dee:
My complaint stems not from not being refused services of money after the fact but being refused service before the fact… I carry disability insurance with Aetna for years when just recently they refused to carry me for an increase of disability insurance because of health reasons which are neither life threatening or require long term medical care just life style changes… that in itself is not the problem. “I did not request the increase my employer did” which is still not the problem, that weekly payment is designed to keep up with a comparable income standard while an individual is off from work… that refusal considers the income relationship of any individual less than an 1/8 of my weekly income while on disability. I do know that several other individuals at my firm have been refusal for the same reasons and that those refusals may fall along racial, sexual, head of household and work positional lines…
I do not know if those refusal are the result of failure of my company to submit correct personal information… however the refusal sets up a chain reaction of tagging individuals as potential health high risks for future coverage… the appeal process are subjects to requiring proof of insurability outside the realm of current health care coverage and long term effects a risk of being charged higher insurance coverage for a health care problem that may or may not exist in the future…Hayden Gallo:
I have a short term dissability claim with Aetna. Every time I have a doctors apointment they demand paperwork that day. They are constantly closing my claim. When you talk to them it’s a different person every time. An orthopedic surgeon sent them limitations on my torn tricep and they say I don’t have a disability. Now my company will not take me back and suspended my medical benefits because of Aetna but my employer wil not take me back untill I have clearance from my doctor. I guess they have surgeons looking at paperwork? When asked if he recieved the 15lbs restriction he said yes. That’s from an orthopedic surgeon I said. He said that’s not enough. I had my doctor, and a physical OD send him paperwork. He said I would have to file an appeal.Attorney Greg Dell:
It sounds like you are dealing with someone at AETNA that is playing games with you. Aetna likely had a nurse or an internal medicine doctor review your medical records. You must immediately request the claim file from Aetna and you will see everything they did to deny your disability claim. Contact us privately if you would like assistance.Thomas W.:
I have paid into Aetna LTD for over 12 years. Well in 2012 I was diagnosed with diabetic neuropathy in my feet. I was placed on STD and then in Oct of 2012 I was placed on LTD for 12 months. In October of this year my LDT was revoked because a new doctor said in a phone interview that I might be able to work. I had only seen this doctor once for an initial consultation. Now I am appealing the decision and was told they where going to use his medical records and not my previous doctor. I have been waiting for there decision for over two months. During that time I have used up my savings accout to pay bills. What recourse do I have if they decline me again? I just do not understand why they will not take my previous doctor’s records.Attorney Stephen Jessup:
Aetna typically only offers one level of appellate review. If your claim is denied again your only recourse would be to bring a civil lawsuit under ERISA. Despite their contentions, it is important that you provide Aetna with ALL of your medical records.Roy:
I recently applied for a re-opening of a closed L and I claim for my back. My claim was denighed after waiting three months. I was then given advice to try and open std with aetna to back pay my private insurance company galleger Bassett. I have faxed in all the paperwork twice, filled out the forms, sent in my denial letter along with my medical info. They have been giving me the run around for weeks and are now saying that my denial letter “sent from L and I” is not a denial letter. Even though it states at the bottom, “the application to reopen your claim is denighed and will remain closed”. These people are thieves.Chanteau Harper:
I have had the same problem with Aetna. I was the victim of a hit and run in Feb. 2011. I was in a company vehicle and was severely hurt. I attempted to continue to work however in May of 2011 I had to have back surgery Aetna Long Term Disability denied my claim saying it was a previous illness because I had back surgery in 2009. Then I had to have neck surgery witch left me totally disabled they got me an attorney and I won my case for my disability in Oct.2012 and then they cut me off not to mention they wanted all of the SSI money back. I got a couple of attorneys to try to fight but the lawyers wont fight they even had a private detective follow me and he had the wrong car the wrong tag the wrong everything and Aetna still didn’t want to pay now all of a sudden I get a W2 for 2013 saying they paid me (I haven’t received a payment since Oct.2012). I is something fishy going on oh they were suppose to keep me on my life insurance as long as I’m disabled but they cut that off in Aug. 2012 and Aetna told me they don’t recognize SSI saying I’m permanently disabled. I could use some help with this case.Attorney Stephen Jessup:
Depending on the status of your case, we might be able to assist you. Please feel free to contact our office to discuss.Brenda:
I was put on a Leave of absence from the company I worked for due to severe Migraines. When I filed for my Disability insurance I was denied them saying they didn’t get paperwork from my physician. When I contacted my physicians they both said they were never sent paperwork. I called Aetna back asked them to send me the paperwork and I would personally get it filled out/signed and faxed back. Once done it was denied again for not enough information, which didn’t make sense since I have worked in this industry and I knew they had plenty of information to approve my case. I was getting 35 Botox injections in my head neck and back to help relieve the pain. I was on a numerous medications ,one medication that requires a PA and was $1600 for 6 pills a month. I resubmitted more information and after 3 levels of appeals it was denied again. I just went back to work after being off for 20 months. I still suffer from the Migraines and have not yet gotten a dime from Aetna.
I know of at least 2 other people from my company who were also denied benefits, one has Lupus and the other had 4 surgeries for a brain aneurism. The system they have inplace is very BROKEN.Rachel:
I filed a STD Claim in October of 2013 and Aetna wrongfully denied my claim and I appealed. My appeal was moved 45 days in January and then after that 45 they moved it another 45 days. They provided no explanation or letters as to why it is being pushed out 45 days. Aetna is incompetent and don’t understand why employers hire them as a TPA when their record is so bad! I’m in the process of filing a law suit and will get every dime I can!Theresa:
Around 2005 I started being sick with multiple symptoms an employee of CCL Pharmaceuticals of Baltimore, I had no choice but to file for my Aetna LTD or be fired for absentee attendance. I strongly suspected a benzene chemical that I had long term exposure that instantly seem to make my head feel dizzy and lungs felt restricted but since their where no occupational doctors or primary cate aware is such medical problems. The whole industrial sickness was dismissed. To make this long story short Aetna Disability denied my claim immediately and CCL also was fighting the claim they where only concerned with production not the human people who dedicated theirselves daily to the heavy workloads. In closing I can just say I won my disability claim by being fortunate enough to run across the documents both companies had forged. I now feel they are violating my civil rights with a new definition of stalking. I’m hoping to catch them so I can on them?Derrik:
Hello. I had to use Aetna disability when I had double hernia surgery. The dates I was to be on disability were from March 12-19 of 2014. Aetna only paid me through the 14th, believing there was nothing preventing me from returning to work. However, my return to work form filled out by my doctor said March 19. My job wouldn’t have even allowed me to return to work earlier than that.Attorney Stephen Jessup:
Your only option would be to appeal the denial of benefits to try to secure the remaining 5 days Aetna would owe you.Sal Aparo:
I had umbilical hernia surgery on Mar. 28th, have been off work since Mar. 14th. I have recieved 2 payments from rialroad retirement and nothing from Aetna. They faxed doctor forms to wrong fax # of doctor’s office, when I called they said they were still waiting for doctor papers. I then took upon myself on April 10th to find out the doctor’s office never recieved these forms. By now I already recieved a payment from Rialroad Ret. Now on Apr. 22 they approved payment. I called to find out I will not recieve a check until Apr. 28th and it is direct dep. 46 days from initial injury i will recieve a check! No liabilty on anyone’s part at Aetna, can’t even get a return phone call from them. Thanks for nothing!!!Byrom:
I made an appeal with AETNA and now they are calling me requesting medical record from November 2012. I asked them if they could provide me the records that they were missing and they said no that I should know that. When I first open my LTD claim with them I provided all my Doctor names, open authorizations to get my records and my doctors send directly the information to AETNA, now they are saying that the records are incomplete! They are asking me for medical records after November 2012, however, during the phone call they were referring to doctors that I have visited prior to November 2012 for some other conditions. What should I do? By the way – the person who called me from AETNA was very, very rude. Thanks.Attorney Stephen Jessup:
Ultimately as the insured it is your duty to provide all medical records in support of disability. As such, if these records are going to be beneficial to proving your disability it might be wise to provide them. That being said, I would warn you to be cautious if there is any indication by Aetna that your condition is caused by a pre-existing condition as Aetna may be looking to solidify its position.Valencia Smith:
On February 20, 2014 I had haglund’s removal, Achilles debridement and bunion removal. Due to my surgery in April I was diagnosed with Complex Regional Pain Syndrome in my foot and ankle. Aetna denied my claim effective April 23. My doctor submitted 15 pages explaining what was wrong and why I couldn’t work. They even explained that I was scheduled to have a sympathetic nerve block on April 25 (which didn’t work). My doctor submitted more paperwork and the claim still wasn’t paid. I’ve submitted an appeal recently, meanwhile I can no longer afford to continue with my medical treatments. I’m not sure what recourse I have now. I am behind on all of my houses bills as well. I need help.Attorney Stephen Jessup:
I am sorry to hear of your troubles with Aetna. As you have already submitted your appeal the only thing that can really be done is wait for a determination from Aetna as to same. In the event that Aetna denies your appeal, please feel free to contact our office to discuss how we may be able to assist you in potentially filing a lawsuit on your behalf.Michael:
I was diagnosed with a chronic condition that has no cure. I applied for LTD with Aetna, and was approved. However, they required me to apply for SSDI or my benefits would be terminated. I did apply for SSDI. In the meantime, they are contacting my PCP every single month, and I have to do recertifications and phone interviews every three months. It’s gotten so bad, that my PCP complained to me at my last visit that he can’t keep sending medical records every month like this. How do I escape this harassing behavior from Aetna?Attorney Stephen Jessup:
Unfortunately, due to the fact that a determination of continued disability benefits is a month to month analysis Aetna is allowed to request information on a monthly basis. Please feel free to contact our office to discuss how we may be able to assist you with the monthly handling of your claim.Gordon:
AETNA approved my LTD Claim in 04/2013. I have had five lumbar fusions surgeries without much let up in the pain. In 11/2013, I was diagnosed with CRPS. There was never an issue with my claim until my case was assigned a new Claim Manager. She said the she had my file reviewed and was going to send me to an IME. I am confused because there were no additional medical records requested since the last review in 04/2014. I called the IME to confirm my appointment and they told me that AETNA has not provided them with any of my records, so I need to bring them all. My Orthopedic Surgeon has indicated a need for more surgery but is concerned about causing further issues with my CRPS. I undergo monthly peripheral nerve blocks in order to control my CRPS, and it is slowly getting better. I do want to return to work and my Doctors and I have talked about possibly working from home a couple of hours per day to see how it goes. However, they do not want to proceed in this direction until the CRPS is better controlled and I have the needed surgery. How can I prepare for this IME? Should I talked to the Doctor doing the IME about my desire to return to work and the conditions?Attorney Stephen Jessup:
If Aetna is sending you for an IME then they have some reason to believe you may no longer be disabled under the terms of the policy. Please feel free to contact our office to discuss how we may be able to assist you.Kimberly:
My doctor put me off work for 4 weeks due to work related stress. Aetna denied my STD claim stating that it was due to work related stress. I haven’t returned to work yet. Is there anything I can do in appealing the decision?Attorney Stephen Jessup:
You will need to review your policy carefully. Some short term disability policies do not cover work related conditions- as your case appears to be. Your only other potential avenue for benefits is through Worker’s Compensation, but you will need to consult with a Worker’s Compensation attorney to better determine what rights you may have.Jillian:
I got into a bad car accident last year 3/4/2013. I have a brain injury and I have been out since my accident. I was on short term disability and then got denied long term disability. I got a lawyer that I did not have pay up front, who pushed my case for several months and then finally put in the appeal. I got denied again. I should be on disability. My company Booz Allen thinks I was never disabled. That makes me look horrible. I know I got the wrong lawyer the last time. What can I do? Please assist.
Please tell me what my options are. I survived up until this point, but since I got denied again my company terminated me and I lost my medical from Aetna. I have a lot of post concussive symptoms and I am in a lot of pain. Stress makes it ten times worse. I paid a lot of money to Aetna for my insurance and disability insurance and I got denied at the time I really needed them. They also held up the one therapy I was doing until I complained to better business bureau.
I want to sue Aetna for all they put me through (stress/going broke/at the point of losing my home and my credit which was excellent is now terrible because I ran out of all my money. I wiped out my IRA/savings to pay my bills and now my one my credit card that was helping me to pay gas and get my medications for my brain injury and pain, decreased my limit by a lot because my credit went bad.
I also want to add that I need two surgeries for some major symptoms and they have made it even more difficult for me. They want me to return to work, but I need to get better to do that. I just don’t understand. Why did I pay for LTD if in the time of need I cant get help that I need.Attorney Stephen Jessup:
Have you exhausted all of your administrative remedies (appeals)? If so, your only option may be to file a civil lawsuit. Please feel free to contact our office to discuss your claim.Disappointed in Aetna!:
Aetna’s Appeals process is a total goat rodeo!
Is the company you work for have any insight or play a role into the approval or denial of STD claims? I was laid off shortly after my leave started and it was denied before the paperwork was even due.
Aetna has a doctor/or child (for all I know) that specializes in a different kind of medicine review your medical charts and denies your appeals claim. This is what they call peer-to-peer review. Wouldn’t that mean a peer to your doctor in the same discipline and not some dude off the street? It’s a total racket!
You try and call and leave messages with a call center since you are never given your Appeal Case Workers Info – you are told to ask the customer service person to IM your case worker and see if they are busy… they are always away or on a call from their home office. I would leave a message about the status, questions or if I wanted to get transferred to their v-mail 4 out of the 20 times I was transferred to someone else’s v-mail.
When your Appeals Manager finally calls you back the first thing you hear is, “Hi Bob”, this is “Sue” from Aetna Appeals and I was returning your call. It’s not worth your time to leave any type of questions or message because they are not going to receive it or they don’t care or they want to see if you remember the message you left a week or two ago.
99.8% of the time they are going to deny the claim. Doesn’t the government regulate any of Aetna’s practices? Don’t consumers have rights when they buy these policies?
Is it the job of the initial case worker or your Appeals Case Worker to actual do anything but push paperwork? Does anyone look at your prior claims, medications, anything at all?
The best part is my STD claim is over 8 months old and my appeal process has taken 5 months. They first denied my claim prior to the due date. The icing on the cake is when I get a so called final denial letter stating all the peer-to-peer meeting they had with my doctors they wrote down that they spoke to all of my doctors but called them men when they were women and vice versa. Is there really proof that they actually called and talked to any of my doctors? One of my doctor’s offices asked that this peer doctor leave a list of questions for the Doctor and she would reply back. That never happened but they still denied the claim stating they were never able to get a hold of him (plus a whole bunch of other things).Attorney Stephen Jessup:
Depending on the funding and authority granted to Aetna in your company’s short term disability policy, your company may have a role in approving and denying benefits. As you have many questions, please feel free to contact our office to discuss your claim and concerns in greater detail.Christina Summers:
My fiance was in a car accident in April of this year. Etna paid him 4 checks even though he was off for 4 months they owe him over 3000 dollars and lie to him everyday, we now contacted an attorney, well we will see what we get out of that. This company has ruined our lives, we are living off my income, we have a house, car, 4 children and every bill you can imagine. If anybody read this: do not use them!Attorney Stephen Jessup:
I am sorry to hear about the struggles your family is facing. I hope your matter with Aetna comes to a positive end.Lola Espinoza:
I received one check from Aetna for my short term disability. Then they denied me the rest of my short term disability . They owe me $2500. I’m back at work but I feel that I’m still entitled to my money. Aetna really left me in a terrible bind. I really need help!Attorney Stephen Jessup:
When Aetna denied your claim for benefits it would have triggered an administrative appeal. If you have not yet appealed the denial of benefits I would highly suggest you do so.Lee:
I have been diagnosed with major depression and anxiety disorder by a pschologist and a licensed counselor. They sent over detail reports with their findings that I am not able to work. Aetna denied my claim because they said they saw me on Facebook with pictures showing me smiling and that I am posting nice statements so I can’t be depressed. I want to know, can I sue them or what should I do?Attorney Stephen Jessup:
Your policy is most likely governed by ERISA, which will require the filing of an administrative appeal before any lawsuit can be filed. Please feel free to contact our office to discuss how we may be able to assist you with same. In the mean time I would strongly urge you to increase the privacy settings on any of your social media accounts to prevent the general public or your insurance carrier from readily viewing the contents of your posts.Nser Krim:
I never seen a poor communication and extreme slow process, like I saw with those people. I believe they are doing that in purpose just to make people give up and think twice before opening a claim again with them in future. I have been in process now for 3 months, too many doctor reports have been sent to them, too many questions have been answered by me over the phone, but nothing happened. I get no response from them for 17 days and after that I got a call from the case manager and guess what, he repeated same questions again an again. Every time I call their answer is I should wait for process with no light at the end of the tunnel.Attorney Stephen Jessup:
Aetna will typically only have 45 days to render a decision on a claim for disability benefits with the potential of a 45 day extension. As you have been waiting for 3 months it would be expected that a claims decision would have been rendered by now. Please feel free to contact our office to discuss your claim further.JJ:
Glad to find this site… then at the same time a little worried, as my wife currently has an Aetna claim and Aetna is planning on discontinuing benefits tomorrow even though our Dr. has clearly stated on two different documents that my wife is unable to go back to work for up to several more weeks. At this point we are embarrassed to go back to our doctor asking for the same information again but we have. We’ve spoken with the Dr.’s office and they are also baffled at what else Aetna wants. I’m learning they are not here to help you they are here to collect your money and then ignore clear instructions from Doctors that state their patient is currently disabled! I’m very disappointed with Aetna!Attorney Stephen Jessup:
Please feel free to contact our office and we can provide you with a free consultation and review of all the documents to determine how we can potentially help your wife with her claim.Edward Thomas:
I filed for Short Term Disability with Aetna on 10/13 by phone. I had been in the ER over the weekend and the physician told me to see my primary doctor – in writing, within 1 day. I was in another state so I took off work and flew home. I advised my employer and took 5 days of PTO. As I headed for the airport I got a call from my company that I was terminated for not being able to meet expectations. That was great. I got into my family doctor on 10/15 who placed me on leave due to Post Acute Stress Disorder (I am 5 months post being in the Middle East). Now Aetna has not approved my claim wanting to verify dates with my doctor. Which really does not matter as I still have the STD insurance for 30 days afterward. I’m supposed to see multiple specialists with no income. So, I’m in a corner. I have to have money to get treatment. Is any advice out there?Attorney Stephen Jessup:
Please feel free to contact our office to discuss the denial and review your policy, as there are multiple issues in play. Outside of their arguing you aren’t covered under the policy, if your condition is related to military service there is a possibility that you would not be entitled to benefits under the Aetna long term disability policy.Theresa Rose:
From all of my experience with Aetna, if you can afford a lawyer, that’s the way to go. They are shady, backed by the Harford Insurance Group. They will probably take the whole 45 days looking for a way out of paying the claim. you have the right to a copy of their records about your disability case. Unfortunately, the employers usually try and help Aetna deny your claims which is an illegal actions of fuguratory abuse on both. For this reason you may be able to also sue the employer if you can prove so. Ask the employer for all copies of corospondance with Aetna about your disability; also get copies of all forms your Dr.s filled out for Aetna and count all dates they will try to use dates against you. Also to deny benefits don’t forget to appeal if denied they are only in business to take your money and / or benefit rights!Linda Melig Sanchez:
I have worked for Aetna since 06/02/2013. I was bullied at my job in San Antonio by the supervisor and some members of my unit! I went through a lot of bulling and harassment. When I first started with Aetna I explained to HR that I was disabled (I am bipolar). The class found out about my illness then the harassment started. I was being told to take my medicine loudly in class by Maria and Lakissa and the manager never said anything to stop this harassment. They all just laughed and continued. After we were finished with class I took 6 weeks off this mess. When we reached the floor the harassment was worse. It was then that I went to HR and they opened up an investigation. The investigation was finished and it was won to my advantage. I got really sick with my diabetics and my nervous system then i became sick with sepsis. My Dr. stated that my body was shutting down. I went out on a short term disability leave. I had so many issues to get this approved. Finally did about 1 month after and not only the pay checks were always short calculations wer not and still not correct. I tried going back to work on October 21 and the harassment started again. See, I was also physically hit by and employee in the ladies rest room. They did not do a thing to her. I reported it and they made her take the harassment courses. There was another ticket open for abuse and I won that also. The manager in that area was removed and the director was released. But now my check are 3 months behind, they are taking their time on renewing my long term benefits. I have not been paid in three months. I want to sue them for assault and abuse and age discrimination, and disability discrimination. Please help! I want to get off this crazy train. Please help me get a settlement for I won’t have to deal with these people anymore. My heart cannot take it!Attorney Stephen Jessup:
I am sorry to hear of all of your troubles. With respect to the workplace harassment and injury you will need to speak with an employment attorney. We can assist you in contacting one. Additionally, depending on when you became eligible for coverage under the Aetna disability insurance policy there may be a potential issue of a pre-existing condition for purposes of the LTD policy. Please feel free to contact our office to discuss further.Gail:
On September 29, 2014, I went to my doctor because I had back, neck, and arm pain. My doctor prescribed me medication, and gave me a letter to stay out of work until October 7, 2014. Aetna approved my STD for that time period, but when I went back to work part time, instead of working my normally 40 hours, Aetna would not approve my claim from October 8th, through December 2nd or for being out for the entire month of December. My doctor filled out all the Attending Physician Statements, listed my condition that was in his doctors notes, included the cortisone injections I had in my neck on 11/10/14, and 12/15/14. I faxed Aetna a copy of my MRI, and X-ray results, plus sent them a copy of a document listing the treatments I received at physical therapy that was written by the physical therapist, but Aetna still denied my claim. I filed an appeal, and explain in details why I believe my claim should be approved. Over, and over again, I did ask my doctor why it was not mentioned to Aetna on the physician statement that my Cervical Spinal Stenosis prevented me from working full because a major part of my job is data entry. I do suffer from back pain occasionally, but, my nerve pain comes from my neck, shoulder, and hand. My doctor, for some reason would not state what prevented me from performing my duties at work. I told them light lifting, and taking breaks from sitting relieves my back pain, but the data entry is the reason I had to be have my hours reduced at work.
Aetna has denied my claim four times, which is really stressful, but the worse part is, since they did not approve my claim, and my employer was paying me my full time pay, I lost all my vacation time away, and is working without any paycheck until I all the money is paid back.Attorney Stephen Jessup:
Is your claim currently on appeal? It is unfortunate the doctor is not properly explaining how your conditions impact your work duties. Please feel free to contact our office to discuss how we may be able to assist you.Ken:
I have Aetna disabilty insurance. It started in June 2014. I got disabled in July with Doctors support and they are turning me down stating pre existing. Under the new health reform isn’t that waived? Plus I had coverage before them. No lapse. Isn’t this illegal? They took my payments! Now won’t pay. They are claiming the affordable care act doesn’t cover the disability side. I’ve read that it covers all medical claims. Please advise.
They payed the STD out and I passed pre existing for that. I thought Obama care affordable care act abolished pre existing period as of jan 2014. I signed up and joined June 2014 and they took payments and I wasn’t told or advised or made to sign any stipulations. I wouldn’t have enrolled if that’s the case.
Please advise.Attorney Stephen Jessup:
Reforms to health care as they relate to pre-existing conditions do not apply to disability insurance policies. Your claim would be subject to the language relating to pre-exiting conditions as defined in the policy.KM:
Aetna seems to be crying for a class action suit. Make sure I’m on the list! They have played games with me for the last 3 years. Denying so many important items. And causing so much trouble in my life! I have considered consulting an attorney. Something needs to be done!Dave:
I hurt my arm in late March of 2015. I went to the doctor and they said that I have an Olecranon elbow fracture, and that I needed to see my primary doctor for further treatment and instructions. I then called my head supervisor and told her I was calling in that Monday to see my primary due to the urgent care report. My supervisor told me that our HR rep on site said due to our policy at UPS, I couldn’t return to work until I was 100% due to their lack of light duty; And that I had to file a short term disability claim, which I did. I have been out of work since. It’s been three weeks. I’ve seen a doctor twice since then with the same diagnosis. Since then Aetna had claimed they hadnt recieved medical records, which I in turn faxed personally and am now waiting for a response. I am becomming broke. What should I do?Attorney Stephen Jessup:
You need to make sure that they are receiving all medical records/forms. I would recommend you send them yourself via certified mail or some other way that allows you to confirm receipt of same.Teri:
I have had ltd coverage through Sedgwick/cms. As of Januaru, AETNA took over. The attending physician statements are not clear leading doctors to provide information that doesn’t detail the patients disability. At this point they are questioning my disability as well as my pcp credentials. My health has declined as I have broken my back twice. What recourse do I have at this point to quickly resolve so as not to loose benefits.Attorney Stephen Jessup:
Disability insurance companies write their claim forms very much to their advantage. Please contact our office to discuss how we can assist you in handling your claim.loreane:
I was hurt on the job, made to take std then it turned into ltd then I was denied from October 2014 to the present time. Now I appealed, they said that my paper work did not prove that I should be out of work. In the mean time I lost my house car. I was depressed all the time. The worker comp dr said I had nerve damage to my left foot. I was taking controlled substance meds prescribed by my pain management Dr. Aetna don’t care about you they just get your money. I need some help.chris stevens:
Yes, I applied for short term disability through Aetna, finally after 4 months they denied my claim saying it was a pre existing condition, because I was diagnosed with edema in my left leg 3 months before, but my injury claim was for an infection of my right leg through a sore on my heel that had nothing to do with edema, Aetna thinks there doctors or something and make there own medical decisions.Attorney Stephen Jessup:
Aetna usually only provides one level of administrative appeal of a denial of benefits. As such your only option at this point may be to bring a lawsuit under ERISA. Please feel free to contact our office to discuss same.Attorney Stephen Jessup:
I would suggest you review the language in the policy for what constitutes a pre-existing condition. Please feel free to contact our office with a copy of the denial letter to see if there is anything we could do to assist you.Attorney Stephen Jessup:
Aetna usually only provides one level of administrative appeal of a denial of benefits. As such your only option at this point may be to bring a lawsuit under ERISA. Please feel free to contact our office to discuss same.Attorney Stephen Jessup:
I would suggest you review the language in the policy for what constitutes a pre-existing condition. Please feel free to contact our office with a copy of the denial letter to see if there is anything we could do to assist you.Autumn:
Someone please help! This has gone on for long enough…
I had a needed hip surgery on 3/6/15 at Virginia Mason in Seattle and went on short term disability for 12 weeks based on my doctors recommendation. Aetna is the provider for my short term disability.
Somehow, the doctors office accidentally told Aetna I will be able to return to work in 6 weeks instead of 12 weeks. Which I was never told. I had no idea until Aetna sent me a nastygram saying that my disability pay and coverage will be terminated immediately on 4/17, 6 weeks too early. And I wasn’t ready to go back to work until 5/29 (12 weeks from 3/6). So I picked up the phone to resolve, what I thought, was a small issue that turned into a huge one.
I called the doctors office and they immediately sent the correction back to 12 weeks until return to work. Despite this, Aetna still decided to deny my request anyway and did not want to reinstate my benefits. I have been on the phone with them 2-3x a day for 8 weeks now asking what else they need to reinstate but they have yet to give me any detailed reason that makes sense. I have been speaking with a claims manager who has no power…she said its up to the medical review team at Aetna to decide fate. And I said why? This was a clerical error…I am not asking for an extension of time away from work. Even my surgeon has sent Aetna several custom letters so that they will quit withholding what I need while out of work.
I have gone over my whole medical file. There is no data supporting that 6 weeks until return to work is valid. Several times in my physician notes they write that I am on track for my 5/29 return to work, which is 12 weeks.
Boeing pays Aetna to administer disability benefits so when I tried to complain to the Washington Commissioner Board say said Aetna is untouchable because they are privately funded by Boeing and they couldn’t help.
So I am, mentally exhausted from getting nowhere with Aetna, with no income, no insurance coverage to go to my really important PT appointments, had to move into a new house and my mortgage is due soon, and Aetna couldn’t care less.
This just isn’t right. They can’t do this to people. Is there anyone out there who can help? I have all of Aetna’s vague denial letters.Attorney Stephen Jessup:
Please feel free to contact our office. Unfortunately, it is all too common that doctors check off the wrong box on a form and it allows an insurance carrier the ability to deny a claim.shandra:
In 2011 I was out of work for knee surgery ..Aetna is used by my company at std…I returned to work in March of 2012 and continued to receive pay from aetna till may of 2012..I then again had to file another claim in July of 2012 for foot surgery and was again approved for benefits through them..only this time when they cut me a check i didnt receive any pay…I called Aetna to find out whats going on and get no response…this goes on for 4 checks and I returned to work Sept of 2012…finally I receive a letter from them in Nov of 2012 that i owe a balance to them of 2664.73…i call and and am told its and overage I owed …and if not paid by 12 of 2012 amount would go up to 3037…i explained they had already took this amount from the previous claim i had had and never received anything again…I am now in 2015 trying to file a claim and am being told i had owed a balance of over 5000 to them and if my claim is approved will not be paid again to pay this back…I called and requested from the person over my claim the supposed letter about 5000 and it does not exist..when i ask her about it and tell her what letters I have and what letters show have been sent on their website she automatically gets angry and defensive and speaks over me where i cant get a word in edge wise….i have reprinted all letters ever sent from aetna and all pay stubs sent from them and all corospondence with them…what do i need to do because i dont feel i owe them anymore money and they will not sent me anything proving i do….i need to be paid this is why my company uses themAttorney Stephen Jessup:
Please feel free to contact our office to discuss your case in greater detail.Della R.:
This is the worst ran company for people in need I have ever seen. They do nothing but give you greif and the run around ,they never have the right documents to proceed with your claim or to further your assistance time off when you will be unable to work. The most stressful time of my life! I have had to call my dr. so many times for paper work they don’t even want to speak to me any more. So un happy with this company what a rip off I paid into this for ten years and now I need my pay.Attorney Stephen Jessup:
Please feel free to contact our office to discuss your current claim status.Anita S.:
I was diagnosed with fibromyalgia on 8/18/15, I applied for st with Aetna and my doctor took forever to send the paperwork and they closed my claim. Finally on 9/18/15 my doc submitted the attending physician for and they denied my claim again for not meeting disability requirements. I’ve been dealing with this pain for over two years now going to different doctors and emergency rooms. I Can Barely Walk Cannot Remember Things Can not bend stand lift anything and have been diagnosed with clinical depression. What can I do?Attorney Stephen Jessup:
You will need to appeal Aetna’s denial. Be advised that Aetna only provides for one level of administrative appeal so it is incredibly important to draft as complete an appeal as possible. Please feel free to contact our office to discuss how we may be able to assist you with same.Jo Anne T.:
Do you handle cases for Aetna employees in GA on LTD who feel Aetna is going to stop paying LTD?Attorney Stephen Jessup:
Yes, we represent claimants nationwide. Please feel free to contact our office to discuss your claim in detail.Chris S.:
I did, and Aetna won my case, said it was a pre existing condition, which it wasn’t.Molly:
I signed up for group LTD/STD through my employer. I filled out their medical information form online and just received a denial for any coverage due to “bi-polar”. They ask on the application of you take medication & if so for what. I am on lamictal for bipolar. I’m not sure what my bipolar that has been treated for 23 years has to do with if I get hurt and can’t work? My director says that I quite possible may have a legal matter on my hands as 1) denying application for a pre-existing condition during open enrollment and 2) discrimination against the mentally ill… is any of this true? Their blatant denial for my “bipolar” was a bit of a kick in the gut. I know my colleague has a heart condition & she was not denied our group coverage?Attorney Stephen Jessup:
Unlike health insurance plans, a disability insurance carrier can deny application for coverage based on medical history. We would be more than happy to review any correspondence Aetna may have sent you relating to the denial of coverage.Stephanie:
I was on disability and approved for short term disability by Aetna for five months for a diagnosis of severe MDD and PTSD. I have severe anxiety attacks and panic attacks. I don’t sleep at night. I cry all the time and can’t think or function to even take care of myself. I’ve been with a psychiatrist and in therapy and have been faithful to my treatment. I was even diagnosed the same with my primary. I went back to work. A month later, I fell again. It is even worst now. Aetna still hasn’t approved my claim and I haven’t been paid. I have had to take a loan on my 401k just to make some of my bills. I’m scared!!!!!! The psychiatrist office provided them plenty of clinical notes and documentation and I was approved before so it is not like this isn’t a viable claim. I haven’t gotten a call. I received a denial letter once and then told they would expedite my claim once they received the paperwork. They got the paperwork and confirmed it with me on 10/1/15. This is 10/8/15 and I have not heard back after several calls and emails. I have to have money to pay for my medicine so I can be healthy. I’m having worst stress and anxiety over this than I had so I’m getting worst. I’m even on a contract for safety. I don’t understand how they can do this? I’m scared.Attorney Stephen Jessup:
Did Aetna deny your claim while it was in the STD period or after it transitioned to LTD? Please feel free to contact our office to discuss your claim and what rights you have at this time.JT:
I am currently covered under an Aetna STD & LTD policy employer provided. After 4 months of my 6 months allows under STD, Aetna has stopped approving my claim. they are bombarding my doctors with paperwork monthly, also calling and talking to my doctors, one of which felt like it was an interrogation. This company needs stopped, and put in their place. My doctors are getting upset with their harassing nature.Arianna:
Hello i have been on short term disability from Aetna since 8/31/2015 until now! I was placed on short term disability because i found out i had a bone disease that affected my knees! My doctor had put me on a restriction and my job did not accomodate me and put me on short term disability! It took from 8/31/2015 until 10/16/2015 for them to come to a decision! Supposedly my job never responded to their requests! On 10/16/2015 i was approved for my claim! I return back to work November 13 2015! Today is 10/30/2015 and i still have yet to receive a payment! What can i do legally because im tired of the run around and i have a child to take care of!Attorney Stephen Jessup:
It is likely that Aetna only administers the STD plan for your employer (as opposed to insuring it) and if that is the case your employer would ultimately be responsible for issuing the payments. I would recommend that you contact HR at this point to voice your frustrations and concerns to try to expedite your benefits.S S:
I got Aetna LTD through my employer as I was considered having lack of competence in my work place and not being able to work effectively in my work place and therefore I was terminated from my work.
I have been diagnosed with MS Secondary Progressive type that so far has no known treatments. My major issues are lack of balance, dizziness, humidity and temeperature intolerant and most importantly cognitive impairment. So many tests have been done to test my cognitive performance and I failed all of them. Until now, I am receiving %60 of my last salary minus SSDI benefits.
Recently I received a letter from Aetna asking to be present at an IME evaluation. The doctor who is going to do the test is a neuropsychologist doctor. My question is that in my employer Life insurance contract there is a small paragraph that under the title
“Understanding your Benefits” it says:
Disability (long-term) For the first two years of disability, you will receive benefit payments while you are unable to work in your own occupation. After two years,
you will continue to receive benefits if you are deemed ADL (Activities of Daily Living) disabled. A person is ADL-disabled if he or she is
(a) physically unable to perform two or more ADLs without continuous physical assistance; or (b) cognitively impaired, and requires verbal
cueing to protect himself/herself or others. ADLs are bathing, dressing, toileting, transferring, continence and eating.
My IME is next week and I do not know what will happen. I appreciate your help.Attorney Stephen Jessup:
The Life Insurance policy will have a different set of standards than the disability insurance. The neuropsychological testing is meant to gauge your cognitive decline- which if the report comes back favorable (which it is expected it would) then you may not have any issues at all from Aetna. That being said, if you do have additional questions please feel free to contact our office.Edward:
How is it that major companies purchase this insurance from Aetna and then it’s the worker responsibility to keep everyone informed of what the other guy is doing ? Not only that but if your on short term they think they can get away with not paying you for weeks on end and when your half way thru recovery then tell you they go from appointment to appointment to pay you… and they don’t even live up to that when they knew from the beggining that you would be out of work for 12-16 weeks to begin with ? Maybe each company should have an attorney take care of the long term and short term disability for the workers so they can get well instead of worrying them to death …. my situation I might loose my truck and house over this unless they pay me what they owe me and even then my company only pays every two weeks so if they do pay I have to wait till January 8 to get money that means they will make me wait 6 weeks for money. That’s bad.Elias B.:
I am UPS employee on disability, I purchased a supplemental insurance which is paid directly from my payroll for over 7 years. Aetna approved my claim but used my supplemental insurance against me as an offset and reduced my claim from 3,000 to 1,000 per month. They claimed my supplement is provided by my employer simply because its taken from my payroll. I was involved in an auto accident and is thereby a no fault injury. My supplement insurance is from another company called Unum. Aetna also informed me that they are also entitled to reimbursement should I be approved by social security disability. Is there anything I can do to appeal this decision in regards to reduced benefits which I feel is totally unfair after paying premiums for so many years for additional insurance to provide for my family should I become disabled?Attorney Stephen Jessup:
We would need to see a copy of both your Unum and Aetna policy to determine what offset rights either may have as many policies indicate that group disability coverage from another company is subject to offsetting your benefit. With respect to the SSDI offset- that is unfortunately correct. Please feel free to contact our office to discuss your claim further.Maxine H.:
I have an Aetna disability claim. I had tendon transfer surgery to repair winged right scapula. My surgery was dec 8,2015. At my two week dr visit I was given an order for physical therapy. I would think the physical therapy payments would be covered because it is part of this claim. When I contacted Aetna they said january 1st was the start of coverage for 2016. Since the pt is happening in 2016 and I have a hsa I will have to meet my 3000 $ deductable before pt would be covered. To me this is just not fair. My disability is guaranteed to january 22nd. What are my rights or do I have ANY in this situation? MaxineAttorney Stephen Jessup:
Unfortunately, as your issue is dealing with health insurance issues and we only handle disability insurance issues we would not be able to offer any guidance.Patti M.:
Stay away from buying any Long Term Disability from Aetna. I was approved on LTD for several years. Then I receive a letter from Aetna stating no longer approved my LTD doesn’t matter what doctors say. Said I was observed one day cleaning off a table and that is one reason they termed me. Another was the notes from my doctor was not good enough. I am not crippled and can wipe a table, I did everything they wanted, saw a doctor once a month as I was on a maintenance to keep my pain under control and had no another reason to term. They requested I file for SSI and in the state of Florida everyone gets turned down the first time. Well I was turned down and they used this against me, as another reason. So much other stuff to…
They sent me a letter on Jan 01 2016 I was termed with no notice and would not make my monthly payment January 21st with no warning. I have two weeks to find a job even though disabled or lose maybe everything.John:
Dear Sir’s, I had Aetna short term disability and it continued to it’s entirety, 26 weeks. When it was time to continue or switch over to long term disability, I was denied. I have appealed the denial and I am currently waiting to hear from an Aetna rep. It was difficult with the short term disability because Aetna requested paperwork almost every 2 weeks from my doctors. It started in the spring of 2015, I went to my primary doctor as I was having costant dizziness and near fainting episodes. I was taken out of work and was subjected to so many test’s to figure out what was going on. They thought it was my heart, my blood pressure, brain tumors, vasal vagal problems and so on. There were so many test’s that did not show anything wrong until I went to a balance and dizziness center for VNG testing, caloric testing. The test results showed that I have a vestibular labyrinthine loss on my left side only (unilateral). Up to this point, Aetna said that all of my symptoms were suggestive and there was no evidence of anything wrong with me. Since having this VNG/caloric test it has been proven that I have this problem. This is now objective/positive proven results that This vestibular loss/disfunction exist’s. My question is why has Aetna denied my LTD since the facts are irrefutable? This is why I appealed the denial and I am hoping that my LTD will be approved. Any thoughts on this? What should I do if I am denied again? I cannot work or function at home because of this vestibular loss. It is really bad and most people don’t understand what it is like to be constantly dizzy and feeling like I am going to fall down, holding onto the walls to manuever in my house and need the use of a cane when there are no walls. I have so many other problems from this that I don’t want to write all now, but I wanted to reach out to You for some insight. Not sure where to turn because the bills are piling up and I have no money coming in. Please help me with some information. Thank You, John from New York.Attorney Stephen Jessup:
John, the denial is likely due to the concept that “Diagnosis does not equal disability.” Meaning, having the diagnosis alone does not mean you are unable to perform the duties of your occupation. To prove disability you have to establish how the diagnosis is resulting in restrictions and limitations as they would relate to work. As your appeal has been submitted, and Aetna could realistically render a denial at any time, it would be best to act quickly to provide any documentation from your doctors to address that point. Aetna typically only allows one level of appeal, so if your claim is denied your only option would be to bring a lawsuit. If your claim is governed by ERISA only the information in the claim file at the time of the final denial can be considered by a Judge, as such it is crucial to have all medical evidence of your restrictions and limitations to them before that potentially happens. In the event your claim is denied on appeal please feel free to contact our office to discuss how we may be able to assist you in litigating the matter. I hope this shed a little additional light on your situation.Teresa J.:
I first purchased Aetna short term disability at open enrollment at my work – I think it was sometime in the last 10 year. Aetna was being sold as a buffer that would carry me from the time I would ever have to be off work until State disability kicked in. As it turns out recently i had to take a leave from work to have a hip replacement. Thats when they started winding me up to run in circles. It was a full month and a half before my claim was approved. Every time i provided them new information as they asked for it, they would think of another item they needed. I couldnt email the information and forms – they had to be faxed. Who has/uses a fax anymore? I had to get a ride and hobble to the office supply with my walker every time they did this. Finally 2 weeks before I was supposed to go back to work they approved my claim. The person who called (I think her name was Huong) said my payment amount was 527.00 per week. She waited a few seconds while I thanked her and then went on to say HOWEVER because you live in California we have to offset the amount you are getting from the state. Long story short they proceeded to send me only $27 per week. I asked them if the $500 goes to the State of California and they practically snicker when they said no. THEY KEEP THAT MONEY. THIS COMPANY IS RUTHLESS. NEVER AGAIN WILL I BUY ANYTHING FROM AETNA.Attorney Stephen Jessup:
Teresa, I am sorry to hear about your experience. Unfortunately, employer provided/offered disability policies contain provisions for reduction of benefits from sources of other income. Social Security disability being the largest, and for residents of certain states, state disability.Jennifer H:
I have STD through my employer. My physician did a surgical procedure and supplied Aetna with dates of surgery physical therapy recovery time that would be needed to recover. I am still required to submit physician notes every week to continue to receive payments. I have to continue to bug my physicians staff to submit information they have already sent.Attorney Stephen Jessup:
Jennifer, during STD it is not unusual for a carrier to request frequent updates. Please feel free to contact our office to discuss your claim further. We wish you a speedy recovery.Tim B.:
I need your address for “claim Form” but envelope lost for address, So you can give me for Your Address.
Audit Number 1455-4355259
Let me knowAttorney Stephen Jessup:
Tim, please be advised that we are a law office that assists claimants in securing disability benefits. If you are trying to contact Aetna, you will need to contact them directly as to your inquiry.Rod S.:
I have been in transportation logistics since 1978.UPS small package, Fed-Ex heavy weight, Air Cargo, freight and now back at UPS Freight. I have Severe Arthritis, in my ankles, Heel spurs , Toe, bone spurs, shin splints,. I am still working Full time. I don’t know how much longer I can take it. I contacted Aetna to have them send me my policy, they told me I was not enrolled. I have been enrolled since I started ,I have no Idea what she is saying>>.. I have spent 37 years getting in and out of there trucks. Now I need some help. Can any one help me. I also have there UPS short term policy and S.S. print out of all my years working. Thank you for your time.Attorney Stephen Jessup:
Rod, I strongly urge you to contact your HR department to find out why it is showing you are not enrolled in the disability policies.Debijc:
AETNA IS A THIEF!! My situation> I had an accident in April 2015 which resulted in 5 major surgeries and 3 weeks of coma and 2.5 months in rehab. I am now in a wheelchair and lost my feet. As a result of all the surgeries, I am in dialysis 3 days a week to kidney damage. I was on STD through another company – no issues there. Then I went on LTD through AETNA 9/15/2015 I received my benefit payments of 60% of my salary Sept/Oct/Nov/Dec/Jan. Then I received a phone call from AETNA stating that I was eligible for SSDI and they were cutting my benefits as a result. They reduced my payments by the estimated amount that SSDI is supposedly going to pay me. However, according to ssdi, I am not eligible to apply for SSDI as I plan on going back to work 7/1/16. AETNA has been paying me the reduced amount since February. Today 3/31/16 I received a phone from them stating that I own them $11,000 in over-payments due to their error. I don’t know how they are going to get blood from a rock as I was living on it to pay bills., had to declare it as income and paid taxes on it. I am made to feel like a criminal for using a benefit I worked for from my company. . I don’t feel that I should have to suffer due to their agent’s neglance/error. They admit it was their error…but they will come back at me for the monies. I don’t know how to handle this situation.Attorney Stephen Jessup:
Debijc, please contact our office to discuss your claim. This is surprising conduct, even for Aetna!Jean:
I have been on disability for four years now. I had aenta which they drop my ltd twice , I won after a year of appeals. Then finally won ss..which I had to pay them back the money the paid to me( to aenta) I received another letter from Aetna I am being denied ltd ..lwhich I don’t have the money to fight them anymore. I am okay with ss disability. The other day I walked out of my house with my cane and very small box with styrofoam in it . A guy in car was waiting in his car in middle of street.( dead end street I live on) he slowly moved his car up and that’s when I noticed he had a camera took my picture and drove off…why would they let me see them and speed off..I did call the police but I didn’t get the plates number just the car make and color..would aenta be Folowing me or is it SS now even though I won my case months ago??????Attorney Stephen Jessup:
Jean, it is not likely that it would be the SSA doing surveillance. If you have received your denial letter please feel free to contact our office to discuss how we may be able to assist you in appealing the denial.Lori A:
I have Menieres Desease and Vestibular nerve damage with 40% hearing loss plus Vertigo weekly and migraines, Aetna has denied my claim I’ve been out of work since February 2016, there is no way I can go back until I have a procedure done on July 8 th hoping it will relieve my symptoms besides my low blood pressure don’t know how to Appeal this? Any advise Aetna sucks!!Attorney Stephen Jessup:
Lori, please feel free to contact our office to discuss your rights and options in appealing the denial.DT:
Extremely unorganized! They lack professionalism. I submitted a claim with all the documentation they needed. They claim they didn’t receive the paperwork and are claiming that they will not aprove until they receive what they need. Their conversations suggest a punitive and condescending tone as if they have no sence of urgency to review or aprove my claim. Rather then helping their customers with their claims, they seem to be interested in finding ways to denied claims.Mikki:
I was diagnosed with MS in 2013 at the age of 42. I was placed on short term disability and then placed on LTD for 18 months. I was placed in the hospital on March of 2016 for 2 days. Iam currently receiving occupational therapy and physical therapy twice a week. I’ve been released recently from pt but still in ot because my dominant hand is in constant pain. My claim is now up for review and per my letter their suppose to let me know if I’m reapproved or disapproved on the 11th of June. My Neurologist has requested for me not to return to work because of the tremors and pain in my dominant hand. My cognitive ability is very poor and after pt is complete I’m to go to Speech. They told me if I get all my paperwork in on time i can have an answer relatively quick. my claim his been in review for awhile and June 11 is over the weekend. Why is it taking so long and I was told that there probably trying to find a loophole to deny me. What are your thoughts? I can’t use my hand do to the pain and weakness.Attorney Stephen Jessup:
DT, have they issued a formal denial of your claim? If so please feel free to contact our office to discuss how we may be able to assist you.Norma H.:
On Sept.25,2015 I was injured at my job of 28 years. I reported the incident and on October 2,2015 I was sent to see our workman comp DR, who asked questions-did a visual and told me my injury was old age and arthritis. He told me he knew how hard my job was and he sent me back to work on full duty. On Oct,16,2015 I went to see an orthopedic surgeon who ordered an x-ray and MRI. On Oct.23,2015 we received the test results which showed that I had a right shoulder rotator cuff tear. He put me on light duty w/restrictions. I took my paper work to my job and returned to work on Oct.26,2015 to the plant managers dismay. On Oct.27,2015 I was taken off my job at 12:45 pm and was told that I was being taken off work at 1 on STD and would be paid in 2 weeks and I was not fired. My union president and I then went to the HRs office and she helped start my disability paper work. As of today June 13,2016 I have not received one check. The HR quit within 2 weeks-my case was then in the hands of corporate HR who quit just before Christmas along w/my union president. My company hired a new HR who refuses to help me and has lied against me several times. Aetna refuses to listen to me and I have sent them every single paperwork that I have but they keep asking me for paperwork while refusing to let me know What they want. I keep telling them I am not a psychic. I am the only woman left and have worked very hard at this steel mill plant!Attorney Stephen Jessup:
Mikki, without knowing about the procedural history of the current application we would not have much insight. However, with that being said a review of a claim for benefits should generally only take 45 days to complete, with a potential of 90 days. Please feel free to contact our office to discuss your claim in greater detail.Attorney Stephen Jessup:
Norma, please feel free to contact our office to discuss your pending STD claim. Did your employer also provide LTD coverage?Thomas R.:
I was out work for 3 weeks in June of 2016 (6th – 25th) for kidney stones. Dr. has sent the paperwork at least 5 times telling Aetna the situation. They ( Aenta) have been saying that haven’t received any paperwork stating my status from my Dr., and I know he has sent it like I said a least 5 times. Still no check, I’ve been back to work since the 26th of June, fed up with this Ins. Any help would be appreciated in this matter….thanks ahead of time…..Attorney Stephen Jessup:
Thomas, I would recommend you obtain a copy of your medical records and send them via certified mail/FedEx/UPS to ensure they are received and Aetna can’t argue its way out of the fact someone signed for the records.Thomas B.:
I am diagnosed with MS disease recently and currently on STD. Vertigo and weakness (lack of control) in my right arm and leg are the symptoms prevented me from continue to work. The vertigo seems to occur intermittently which is, something I believe can be managed with the right prescription drug. As for the weakness of my right arm, although this makes it extremely difficult for me to type on a desktop keyboard, but I am more than willing to cope with this difficulty. My biggest concerns is the weakness of my right leg. I don’t have a lot of control on my right foot to keep a steady speed when I drive or step on brakes. I checked in with my boss and he has informed me that my company can’t accommodate an option for me to work from home remotely because I am a non exempt employee. Do you have any advice for me?
I was discontinued LTD after the 24 months, although there was never any question about receiving the LTD prior to that. My doctors notes are all quite detailed, yet they used an initial specialist, from the beginning of my treatment, who suggested that I not take the meds I was was for Fibromyalgia. I then went on to try every other medication suggested, with disastrous side effects (one requiring and ER visit), until with further testing it was determined that I have Ehlers Danlos syndrome (Fibromyalgia is still on the diagnosis in my charts, but the reasons for the narcotic pain medications are severe back pain, and overall body and joint pain from the Ehlers).
The denial completely disregarded the very detailed information regarding what I can and cannot do that my doctor sent after every visit, the new diagnosis of Ehlers Danlos, the worsening disc degeneration in my back, as well as side effects of the medications I take for any quality of life.
In the denial, one of the occupations they said I could do was the one I had been doing prior to having to leave work. It involved lots of driving, lots of sitting, extreme levels of stress to maintain schedules, deadlines and documentation of work performed in the course of my job. These things were all addressed, over and over, in the course of my treatment with my PCP and other specialists.
The denial even went so far as to say that I owed them money for an overpayment.
When I received the administrative chart, it was glaringly apparent that all the people who signed off on the denial did not review the chart in any detail, as there was another person’s information in my file, that was sent to me. (I did file a complaint due to the HIPAA violation.)
There was information from the investigator regarding social media posts, none of which contradict anything I claimed within or without my abilities, except one, but that picture was taken prior to leaving on disability, and in fact had been addressed in a notarized statement when I appealed the denial from short term to long term (which they obviously did approve).
Given all this, and I have only touched on the glaring lack of due diligence on their part, I do hope that I can find a lawyer to assist, either with the appeals process, which is coming due soon (local lawyers have declined to take it due to lack of money they will receive), or if I need assistance after this appeal by taking it to a higher level court.
Thomas, if you are unable to work, your employer disability plan(s) may be your only viable options for income. Please feel free to contact our office to discuss your claim/policy in greater detail.Attorney Stephen Jessup:
Tanya, it is imperative that you submit your appeal within 180 days of the denial or you could be barred from bringing suit. Please feel free to contact our office to discuss your claim and how we may be able to assist you with the appeal.Nadine:
I believe Aetna is a crooked company. When I was on leave during my pregnancy Aetna denied my claim because they said they were not able to speak with my doctor. How is it I am able to get through and they can not. I’m on a medical leave, and guess what they can not get in touch with my doctor. I dint think they even make calls, I think they just pretend to get in contact what type of tracker system is in place none I bet, I bet they get compensation for denying claims.PD:
My Husband received STD/Long Term Disability benefits through Aetna along with Workers Compensation benefits. He also applied and was approved for Social Security Disability benefits. Given the benefits were retroactive, he was advised his LTD would be suspended under subrogation rules for approximately 3 years. When we contacted Aetna as it got close to the end of the 3 year suspension period, Aetna informed us his claim was closed, cancelled, and no further benefits would be paid. They said they tried to contact my husband and did not receive a response. However all his information including cell phone number address etc was on file with Social Security Office. We faxed numerous requests over the years to AETNA to try to reopen his case, and letters were ignored. His benefits should have been in effect until the year 2025, and I feel like he has been robbed of what was rightfully his entitlement. Do we have any further recourse. He is still disabled, has always been seen regularly by doctors, and this just seems unjust to me.Attorney Stephen Jessup:
PD, when did Aetna advise that his claim had been closed? Have they since sent you a copy of the denial letter? Please feel free to contact our office to discuss what options and rights your husband may have in securing his benefit again.Tiffany:
I have been a migraine sufferer for over 10 years and recently had to stop taking my medications that were helping to reduce the number of migraines that I have due to pregnancy. I spoke to my manager at work as well as my OBGYN and neurologist (who I’ve been seeing for the past 10 years) and they all agreed that I needed to be out on STD due to the consistent migraine that I have had since my second trimester began end of May 2016. On top of the migraines I was diagnosed with Gestational Diabetes making my pregnancy high risk and having been put on medications to help stabilize my glucose levels which have been elevated due to the stress of the situation and the migraines. I filed a STD claim with Aetna June 9, 2016 which was denied July 1, 2016. I immediately submitted an appeal request which started on July 12th and just now received a letter stating as of September 7th is going to be extended an additional 45 days til October 25th due to them “pending the results of several requested specialty matched medical opinions on my claim file.” I was told that their neurologist, who has never examined me, spoke to my neurologist of 10 years and that “it did not go in my favor”. I have faxed them every document that they requested within 24 hours and have been following up with both my OBGYN and neurologist, having both send over the doctor’s notes within 24 hours. Now they tell me they need an additional 45 days for what? They have not requested any additional paperwork from me or my physicians. At this point I am three months out of pay and living off of credit cards to try to keep up with my household bills. I have a baby that is due in 8 weeks and no way to be financially ready for this child due to not getting paid and unable to return to work until after the delivery.Attorney Stephen Jessup:
Tiffany, during the course of an appeal Aetna can exercise a 45 day extension to render a decision on the appeal, so they are within in their rights. That being said it from what you are saying it does seem strange that they would exercise it. Please feel free to contact our office to discuss the claim further.Cami:
I worked for a company called Payflex bought Aetna. When they took over all hell broke loose! I work as an escalation supervisor processing claims for health accounts. They are a horrible company to work for, when I got sick and filed for short term disability they denied me so I filed an appeal and they denied me again! It didn’t seem to matter what my doctor said & he was actually very upset that they denied me. I have multiple health issues my. So I had many ups and downs mostly bad days because they were still trying to find the right combination of medications that work for me but I did have some better days in between. I’m trying to keep this as short as possible without putting all of my business out there but I was denied because of one statement that my doctor made! That was my eyes looked bright and it look like I was feeling a little bit better on that day! I couldnt believe it I was shocked & Not only was this my insurance company but this was my employer! I wish someone would help me go after them! Payflex was a great company to work for until they took over!!!C ODonnell:
I just received my final disability check from a car accident in 2001. I had it payed out oover 15 years because I had to give half mf my claim to another person involved. Is this insurance taxable by the IRS?Attorney Stephen Jessup:
C ODonnell, you will need to speak with an accountant or tax professional as to the taxability of your disability benefit.Lost for Words in FL:
I was out on a short term disability for a Kidney pain and a Tumor. During this time I was suffering from a great deal of pain and passing of blood. I am also a Diabetic and suffer from Jorums. I was put out on a STD for a month. Aneta has been giving me the run around and denied my claim. I appealed the decision and they keep pass along the time and not giving me a straight answer or approving or denying my appeal case. They are really rude and the case managers or the supervisors can keep their story straight. Don’t they have a time limit to make a decision on an appeal case? Mean time my family is suffering and I still out a months pay. I feel alone fighting a Giant. My employer will not help either.Attorney Stephen Jessup:
Lost, please feel free to contact our office to discuss the denial and your subsequent appeals to see if there is any assistance we can provide you at this time.Karen G.:
Currently under review from Aetna to close my disability claim. My neurologist supports my inability to work either part time or full time. My primary care physician states the same. I have had many health issues over the last 23 months and they have been paying.
I am doing much better now but with many attempts at different treatments for migraines I still suffer 25+ days a month. They are shorter in duration but unpredictable and the relief leaves me barely functional at home after 6 hours ir so under the influence of the treatment.
I will be LITERALLY living in my car after the 30th of October if they persists in the tac they are on.
I need helpAttorney Stephen Jessup:
Karen, please contact our office to discuss your claim in detail.Lisa:
I have been denied my LTD by Aetna after 8 years of payouts. I believe the policy I obtained while I was at Delta Airlines is a non Erisa policy however I do not have a copy of it and Aetna refuses to send me a copy of it. They have twice sent another companies policy or only a few select pages from some unknown policy. They have also removed 6 years of records from my files and refused to send them to me. I was told years ago that my policy was unique and that I did not need to be 100% disabled to qualify, thus the 8 years of payouts. I feel that Aetna got tired of paying me and just ended it regardless of the policy. FYI, I damaged both my knees in a work injury and could not perform my duties as a trainer of lifting 80lbs. I have solid Doctors and 6 surgeries behind me. I’m currently formulating my appeal. What are your thoughts?
Lisa, please contact our office to discuss the denial. It is likely your policy is governed by ERISA as it was provided by employer but there may be a question as to who is liable for benefits under the policy. There are only a handful of exemptions that make an employer provided policy non-ERISA.Tony:
I guess the status of the disability claim is approved now, it has been months ago and months to get here as the delayed approval was unexceptable, they messed up and started two claims on me and so all this time they request more documents ones I’ve already sent twice all because of one lady woukd take half to documents the other Lady would take half so when finally able to talk to a Manger after 3 times being denied saying they don’t let you talk to mangers. I got his attention and he says now between both of the claims we finally have enough paper work to do one claim and should have answered on that soon .. my family and myself are a mess house is in 3 months late, trucks car late everything late and I want to sue aentna for everything they have caused us my medical condition is worse don’t sleep don’t eat cause I don’t know when there actually gonna pay so I give all food to my girls to make sure there ok, I was told last 3 weeks oh you’ll get paid by Monday, and now thinking I was gonna get paid today and nothing again. I did get an email saying I was approved and back pay would be granted but nothing about paying my late charges or paying for pain and suffering or stress so bad I have sores all over my legs or headaches I’ve never had where I can’t get out of bed, if they would have listened to me at 1st when I told her this is a reinstatement claim my family and I would never have been going through this mess they put us in. Instead they open a new claim and a reinstatement claim and I guess half the papers go to each one min I have everything in and there making a decision to next ssy8nh they haven’t received anything. Please at least hear me out before making a decision they should never be allowed to do this to family’s out there that works so hard and pays for this ins. Through employer, my employer even had to send things twice each time and could not believe what was going on.Rob Stull aka Slim:
I worked for UPS for about 14 years as a driver, when suddenly I got a severe pain in my back while lifting a package. I was in so much pain that I could not work. I will spare you are the details of what a horrible bunch of inhuman pieces of you know what UPS management is. I was told that I never could of hurt my back on the job. I don’t know if many of you know what our job entails , but it is a very demanding job both mentally and physically. My Union (Teamsters) hired me legal representation and after a year and a half UPS charged it to Workmans Comp and had it paid by another insurance company. In the mean time Aetna is suppose to pay me a percentage of my wage up to 5 years. It is actually $3,000 a month, due to the hourly wage of $35.10 I was making. I am scheduled to have my fourth knee surgery , 2 on each knee , and I was diagnosed with manic bi polar disorder and severe anxiety disorder. I was having panic attacks so often and so bad, that you thought you were having a heartache. The exact same symptoms and you thought for sure you were dying. The most horrible thing I have ever experienced. Now Aetna contacts me to inform me that Im a prime candidate for disability and they hired a very experienced and reputable company named Allsup to represent me. I know how slimy insurance companies work. The sooner I’m on disability, the sooner they stop paying me. Then after I got everything lined up with Allsup for my disability hearing, Aetna sends me a letter saying that I should be able to find work as a stamp licker and January 21st 2017, my money is cut off. One minute they tell me I can’t work, then Im fine too. They have all my medical records and doctors recommendations, so those cheap SOB’s are full of shit. I have 4 titanium pins holding my spine in place, one knee after 2 operations hurts worse than it did, and the other one has a torn meniscus for the second time. There are days when my back and knees both act up that I can’t even walk. Aetna said that there should be something I can do within my long list of restrictions from my back sorgeon. They only pay if your off due to work related issues for up to 5 years per our union contract. the problem is that Aetna didn’t realize I got paid for a knee injury also, so they did not take into consideration my restrictions from my knee surgeon. They say my mental health issues don’t fall under under work related, but the way I was treated after all those years of loyal service without a single injury, it made my mood go haywire. The stress flared up my manic episodes where you’ll literally stay up for days without sleep for no reason. Its just the fact you can’t slow your brain and body down. Aetna is a bunch of hypocrites and your typical slimy, rip off ,no pay low life insurance company. I hope the CEOs or whoever makes those rules to screw the needy knows that one day they’ll meet their maker. I know that greed and selfishness doesn’t set to well with the big man. Id rather die a poor man money wise, at least knowing ill die a rich man from helping others when possible and being kind and compassionate towards my deserving fellow man. I wouldn’t let Aetna put insurance on my worst enemy or even the neighbors dog I don’t like. They even deserve better. I hope they can honestly go to bed with a clear concious at night, because I know I truly do. In the afterlife I would dress light, Aetna the crooked, dishonest company. Im sure some of your sheepeople will follow. No brains makes it easy to control your employees, but not me.Attorney Stephen Jessup:
Rob, you are a victim of an all too common insurance practice. They require you to apply for SSDI as the policy requires it so they can save money, but still evaluate the claim to finds ways to terminate your benefits. Please feel free to contact our office to discuss your claim, the denial of benefits and your right to appeal.Caretha M.:
I was placed on loa June 2016 for medical and behavorial health issues my case was in process for an ext for the behavior health and the case Manger waitem a week after the my deadline to deny me saying the documents sent weren’t enough instead of reviewing it before hand and giving me enought time to get it in…I started my appeal in Sept when the case was denied and the case Manger drug her foot from Sept until today she kept saying I’m going to need more time more paperwork then I need to speak with the drs all of this I complied a d she waited until today the last day of her ext and denied me I also had surgery after the appeal last month which I was denied for due to them sating it was under the same case I’m out of money because I had to pay ins for those months I’m out of savings from catching up on bills because these ppl st aetna want to play god and say what’s seriousAttorney Stephen Jessup:
Caretha, if Aetna has denied your administrative appeal your only option at this point would likely be to file a lawsuit under ERISA. Please feel free to contact our office to discuss same.Damion:
I filed for short term disability in Septembert through my employer for back issues. Because I was aware of the difficulties in having Aetna aprove anything I made copious calls to the office to confirm the necessary info was received for review. Aetna pays out immediatly with my employer and if denied funds are recouped. I filed on 9/13 and received 2 checks and was denied on 10/13 for any ongoing pay. They indicated they did not have information regarding PT that my DR prescribed,;however, I called 9 times to confirm they did not need additional info before being denied from 10/5-10/13 I was told my agent was not avaialable as she was located in FL and they had to be evacuated for a hurricane. I was also told if Aetna needed any additional info they would contact me or my physician as part of the intake i advised I was attening PT and my CO insurance is also through Aetna so the PT sessions show on Aetna’s web. Aetna denied indicating they had no info on PT. I was then advised apeal could take up to 45 days, even though I was adament i did my due dilligence calling 9 times to see if any additional info was needed I was told it would still take such time. I was required to fill out additional paperwork, send an appeal letter, have dr fill out additional paperwork and they would review it. After making no headway with apeal agent assigned I requested a MGR who told me a clinical review would be needed and would take up to 15 days, explaining my financial state and my contention it was not my fault there office wasnt open and denial was hastly done after log jam of cases I asked to have expidited- he said to make my DR aware of the call and if calls were not returned a fax would be sent. I called and saw Dr multiple times. on the 17th day and Aetna rep called on a Friday and Monday 20th day and then appeal was denied for no info returned. this was also on Thanksgiving week and no one at Drs has a record of call. No fax was sent. I didnt receive denial until the 28th day (of the 15 day period) and requested a MGR again. Mgr said he listened to the call and had assigned his team leader to it. Team leader said she faxed form to Dr and it would be max 5 days after returned for decision. the document was recvd by Aetna 12/5 and as of today they still indicate it is under review. I have not received my last 5 pay checks, auto and health insurance has been cancelled, eviction hearing was Tuesday and I’m sure they are going to come back and deny claim. BTW PT indicated inabilty to perform duties, primary as well, MRI shows herniated disks, stenosis,tear, and other terms I cant understand. I was referred to a specialist who had scheduled a lumbar epidural;however I had to cancel it because my health insurance was termed due to non payment of premium. I’m losing everything and I can’t even move me possessions before repo due to multiple herniated disks. Ultimately this all comes down to them not reviewing my intitial claim properly because of the storm and office closure. Is there anything I can do? Insurance commisioner meeting is 60day process so no benifit in saving home.Attorney Stephen Jessup:
Damion, unfortunately, there is potentially very little that could be done to bring a quick resolution to the matter- meaning even if you filed a lawsuit for failure to render a timely decision on the appeal, that would still take months to get anywhere with. Aetna typically allows for only one level of appeal so if the appeal is denied your only option would be to file a lawsuit. If there is a denial of your appeal please contact our office to discuss your claim further.Dawn M. K:
My mother recently passed. She was out on LTD ( for lung cancer) when she passed, which started Nov. 3rd. On December 21st she was paid ( by direct deposit )for her month (dec) of LTD. My mother passed on December 24th. I called and notified her employer and Aetna on the 27th of her passing. I specifically asked BOTH for a return call to find out what happens next. Later that evening ( since the time difference on west coast, and where her rep resides) I received a call back from my mothers rep. from Aetna. I again specifically asked what happens now with the ltd benefits and she stated exactly to me that they will send a letter requesting the death certificate and I will receive a letter about an over payment since my mother passed on the 24th and she was paid for the full month, she was over paid from the 25th – 31st (7) days. Ok fine, not a problem, I just have to pay the over payment back… so I was told and thought until the 30th when I see a debit showing on my mothers account for the full amount of the check she was paid on the 21st. I called and asked what the hell was going on, had to wait for west coast rep to call back and she stated that since the payment was still pending ( which is a lie) that it’s their policy to reverse the check, correct the amount and send out a paper check made out to my mothers estate…. this itself is a problem since their isn’t an estate. My mother paid cash for everything, doesn’t own real estate and paid everyone of her bills. Other then that, the money they gave paid her on the 21st processed into her account on the 22nd and we paid her monthly bills with that money. So now I’m using my money to pay her bills since they sneaking took the entire money back. Can I sue them for this and add pain/suffering to it since this has all but killed me from the stress on top of the grief of loosing my mother. Please help!Carol:
Have been dealing with these people since August 3, 2016 things were great in the beginning then they started losing my paper work so in would have to call my doctors and have them resend the paper work. All the while they are not paying me for weeks at a time. My case worker is always 2 weeks behind and I am always waiting 3 weeks to get paid from these people. I am so tired of dealing with these people. If I was incompetent at my job as these people are I would get fired. I just want what is owed me I paid for this insurance, why can’t they just do their jobs?Attorney Stephen Jessup:
Dawn, I am sorry for your loss. Unfortunately, there is no remedy against Aetna for any pain and suffering. Have they responded to your inquiries regarding the benefit? Also, I would also recommend you inquire about the “Survivor Benefit”- most policies will pay three months of benefits to a Survivor. Also, I would inquire if your mother also had a life insurance policy with Aetna (or another insurance company), as it is common an employer provided Disability and Life Insurance.Attorney Stephen Jessup:
Carol, please feel free to contact our office to discuss your claim in detail and how we may be able to assist you with your monthly claim.Stressed Person:
I need help with a denial from Aetna that was approved then later taken back and back dated to beginning of claim. Per my work they said they have nothing to do with denials and approvals… but I have an email stating that they asked Aetna approve then they took back. By them doing that it took me to unpaid leave which my work decided to over draw checking then reverse out. Now I am stressed about my pay because they wanted to take 500.00 out of each check if I don’t set something up which they choose the amounts and do not realize that I will experience a financial hardship. I am so stressed out can’t sleep at night. This whole leave was a nightmare.Slavka:
My pregnancy began in May 2016 and due in Feb 2017. In 2016 I wasn’t enrolled into STD, at the end of the year I enrolled in STD for 2017. Jan 20th I received letter from Aetna denying my STD claim due to preexisting pregnancy. Can they deny my claim for STD due to pregnancy because it was preexisting?Attorney Stephen Jessup:
Stressed Person, please feel free to contact our office to discuss your claim in greater detail to determine what assistance we may be able to provide.Attorney Stephen Jessup:
Slavka, unfortunately, disability insurance policies come with pre-existing condition provisions that are enforceable. Disability policies do not act in the same way as health insurance policies and pre-existing conditions.SO:
I am on disability through Aetna because of the neurological effects of a stroke. My condition has essentially been the same for a year and half in that some of the physical effects of the stroke diminished, but I still have permanent effects, specifically with my speech and with neurofatigue that makes it impossible for me to stay awake a full work day and keep a schedule. My previous job was one where I spoke a great deal of the time at a high level of communication. The problem is Aetna has absolutely no understanding of what my disability is as they have my neurologists fill out this form as to whether I can bend, lift 50 pounds be in a hot environment etc. This isn’t even part of a neurologist exam and the doctor couldn’t tell this in their exam of me. It’s not like I have a broken arm or back that’s going to heal after a few months. I have a brain injury. And all that physical stuff could be faked if I wanted to go to the lengths of trying to fake it. I’m not. That’s not how I’m disabled.
3 different doctors are never able to give them what they need and it’s always a nightmare. Now I’m on Medicaid and my last appt. was at a public hospital and i can’t even speak with the doctor and I’ve sent Aeta 4 different forms I’ve gotten from doctors since January and they still say they don’t have the right thing. Is there anything I can do about this to get them to stop harassing me and realize my problem and that all disabilities aren’t the same?Attorney Stephen Jessup:
SO, it certainly sounds the Aetna is setting your claim up for a denial. Please feel free to contact your office to discuss your situation further and to determine how we may be able to assist you.Jeremy:
I got denied and got fired right after my Dr submitted my paperwork for leave, due to being in the hospital. They fired me for being in the hospital. and now paying unemployment wages to find a job since I was terminated for being in the hospital and trying to get FMLA set up.Attorney Stephen Jessup:
Jeremy, when was your claim denied? Did you file an appeal? Please feel free to contact our office to discuss the denial of benefits to determine what rights you may have to pursue your benefits with Aetna.Cindy E.:
I have been out of work since October 2016. I was receiving std until 12-18-16. Then they denied my claim. My Dr. has been sending in form after form and Aetna says its not enough physical findings to back up my disability. My family Dr is also seeing me for medical reasons and sent in forms stating I was unable to work. They are currently reviewing her notes. I’m hoping it will get approved, but, not expecting that to happen. What steps do I need to take in order to get my disability pay?Pamela L.:
My story is the same as most here. I suffer from several afflictions. T1 diabetic for 42 years, stage 3 kidney disease, neuropathy pain in feet legs and hands, carpal tunnel in both hands, seizures, etc. I was being paid for short term. I had 2 weeks to go to go on LTD, and Aetna started saying they were not receiving the correct paperwork from my doctors. I had a primary and 5 specialist. Each which was sending copies of their visits. If they said they did not receive it, I would fax it myself. They put me on unpaid leave, and it got to the point where I had to early retire. the people I talked to from Aetna were very very rude. They would not return phone calls. They would lie. I have all my paperwork stored to back up what I am talking about. I am now having to start over with new doctors because I lost my insurance due to inability to pay. I’m on Medicaid now, the doctors don’t care because of this. This has been a horrible experience. Living on pension which the government will take most of because I had to early retire. Waiting to go to court for an appeal to try and get on disability. The system does not work. These people are out for whatever benefits them only. Thanks for letting me vent. I hate Aetna.Sarah:
Aetna denied my claim after providing all my doctor notes 5 times, all my ER records. stating that i did not see my doctor until 3/3/17 but my out of work date was 2/16/17. I had an appointment with my doctor on 2/17/17 but due to my condition I fell and ended up in the ER, again all this has been documented and sent to Aetna. I am extremely frustrated after having them send the wrong requests to the wrong doctor numerous times, Once I got that straightened out and provide EVERYTHING UNDER THE SUN FROM ER RECORD CT SCANS BLOOD WORK EVERYTHING THEY DENY MY CLAIM. I pay for their coverage and now they are not paying me? This sounds highly illegal. I went above and behind all documents requested. Aetna is definitely committing a crime and they need to be stopped.Attorney Stephen Jessup:
Cindy, is your claim currently in an appeal review – as in you had to file an actual appeal to a denial letter or is Aetna reviewing the updated information to determine if the updates will start the benefit again. Please feel free to contact our office to discuss your claim further.Sebastian M.:
Me and my father work for the same company called Harris Teeter. I am still under his insurance. I recently had to take an fmla leave for a double herniated disc surgery on my L5 and S1. My leave was approved due to my company being very understanding. My job isn’t a simple nor easy job I am a Selector for the grocery chain. We pick up 5-50 pound cases of dry goods for the stores and it isn’t just one but multiple cases ranging from 1-350+ cases depending on the order. My surgeon stated I’d be out of work after the surgery which was on February 16th, 2017 and my doctor stated I could not return to work until around May 16th. He put me out of work for 12 weeks. Aetna only approved me to the 4th of April and the claim manager actually told me it was gonna be shorter but she had it extended to April which still was not enough time. My doctor put me out that long to regain strength in my left leg and lower back because it got to the point where I could hardly get out of bed and move around. When I noticed the short time I called a week ahead of the expiration date and a woman told me it would be taken care of and she would leave a note for my claim manager. My claim managers name is Leslie Polasek. She tried to tell me I could back to work this and that but considering she more than likely had no medical background I stated my next doctor visit is not until May 1st, 2017 and on that next visit I will get an exact date of medical clearance to go back to work. The company I work will not let me go back to work unless I have doctor medical clearance because they understand. Since I called and made a fuss about it they are “faxing but the surgeon and my family doctor who recommended me to the surgeon. How long should I wait before taking appropriate action?Attorney Stephen Jessup:
Pamela, what is the current status of your claim with Aetna? Please feel free to contact our office to discuss what options/rights you may still have against Aetna.Attorney Stephen Jessup:
Sarah, as your claim has been denied your next step is to file your administrative appeal. As Aetna typically only allows for one level of appeal before a lawsuit must be filed; as such your appeal is very important. Please feel free to contact our office to discuss Aetna’s denial and your rights going into Appeal.Attorney Stephen Jessup:
Sebastian, if your claim is denied you would have rights to file an administrative appeal. If the benefit is being paid then you have no legal recourse at this time. Please feel free to contact our office to discuss your situation further.
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Vehicle insurance (also known as car insurance, motor insurance or auto insurance) is insurance for cars, trucks, motorcycles, and other road vehicles. Its primary use is to provide financial protection against physical damage or bodily injury resulting from traffic collisions and against liability that could also arise there from. The specific terms of vehicle insurance vary with legal regulations in each region. To a lesser degree vehicle insurance may additionally offer financial protection against theft of the vehicle and possibly damage to the vehicle, sustained from things other than traffic collisions, such as keying and damage sustained by colliding with stationary objects.
- 1 History
- 2 Public policies
- 2.1 Australia
- 2.1.1 Compulsory Third Party Insurance
- 2.2 Canada
- 2.3 Germany
- 2.4 Hungary
- 2.5 Indonesia
- 2.6 India
- 2.7 Ireland
- 2.8 Italy
- 2.9 New Zealand
- 2.10 Norway
- 2.11 Romania
- 2.12 Russian Federation
- 2.13 South Africa
- 2.14 Spain
- 2.15 United Arab Emirates
- 2.16 United Kingdom
- 2.16.1 Investigation into repair costs & fraudulent claims
- 2.17 United States
- 2.1 Australia
- 3 Coverage levels
- 4 Excess
- 4.1 Compulsory excess
- 4.2 Voluntary excess
- 5 Basis of premium charges
- 5.1 Gender
- 5.2 Age
- 5.3 U.S. driving history
- 5.4 Marital status
- 5.5 Profession
- 5.6 Vehicle classification
- 5.7 Distance
- 5.7.1 Reasonable distance estimation
- 5.7.2 Odometer-based systems
- 5.7.3 GPS-based system
- 5.7.4 OBDII-based system
- 5.8 Credit ratings
- 5.9 Behavior-based insurance
- 6 Repair insurance
- 7 See also
- 8 References
- 9 External links
Widespread use of the automobile began after the First World War in urban areas. Cars were relatively fast and dangerous by that stage, yet there was still no compulsory form of car insurance anywhere in the world. This meant that injured victims would seldom get any compensation in an accident, and drivers often faced considerable costs for damage to their car and property.
A compulsory car insurance scheme was first introduced in the United Kingdom with the Road Traffic Act 1930. This ensured that all vehicle owners and drivers had to be insured for their liability for injury or death to third parties whilst their vehicle was being used on a public road. Germany enacted similar legislation in 1939.
In many jurisdictions it is compulsory to have vehicle insurance before using or keeping a motor vehicle on public roads. Most jurisdictions relate insurance to both the car and the driver, however the degree of each varies greatly.
Several jurisdictions have experimented with a "pay-as-you-drive" insurance plan which is paid through a gasoline tax (petrol tax). This would address issues of uninsured motorists and also charge based on the miles (kilometers) driven, which could theoretically increase the efficiency of the insurance, through streamlined collection.
In Australia, Compulsory Third Party (CTP) insurance is a state-based scheme that covers only personal injury liability. Comprehensive and Third Party Property Damage insurance are sold separately.
- Comprehensive insurance covers damage to third-party and the insured property and vehicle.
- Third Party Property Damage insurance covers damage to third-party property and vehicles, but not the insured vehicle.
- Third Party Property Damage with Fire and Theft insurance additionally covers the insured vehicle against fire and theft.
Compulsory Third Party Insurance
CTP insurance is linked to the registration of a vehicle. It is transferred when a vehicle already registered is sold. It covers the vehicle owner and any person who drives the vehicle against claims for liability in respect of the death or injury to people caused by the fault of the owner or driver, but not for damage. It covers the cost of all reasonable medical treatment for injuries received in the accident, loss of wages, cost of care services, and in some cases compensation for pain and suffering.
In New South Wales and the Northern Territory CTP insurance is compulsory; each vehicle must be insured when registered. A 'Greenslip,' another name by which CTP insurance is commonly known due to the colour of the form, must be obtained through one of the five licensed insurers in New South Wales. Suncorp and Allianz both hold two licences to issue CTP Greenslips – Suncorp under the GIO and AAMI licences and Allianz under the Allianz and CIC/Allianz licences. The remaining three licences to issue CTP Greenslips are held by QBE, Zurich and Insurance Australia Limited (NRMA). APIA and Shannons and InsureMyRide insurance also supply CTP insurance licensed by GIO. In addition to the Greenslip, an additional car insurance can be purchased through insurers in Australia. This will cover claims that the standard CTP insurance cannot provide. This is known as a comprehensive car insurance.
A similar scheme applies in the Australian Capital Territory through AAMI, GIO and NRMA (IAL).
In Victoria, Third Party Personal insurance from the Transport Accident Commission is similarly included, through a levy, in the vehicle registration fee. A similar scheme exists in Tasmania through the Motor Accidents Insurance Board.
In Queensland, CTP is a mandatory part of registration for a vehicle. There is choice of insurer but price is government controlled in a tight band.
In South Australia, Third Party Personal insurance from the Motor Accident Commission is included in the licence registration fee for people over 17. A similar scheme applies in Western Australia.
Several Canadian provinces (British Columbia, Saskatchewan, Manitoba and Quebec) provide a public auto insurance system while in the rest of the country insurance is provided privately [third party insurance is privatized in Quebec and is mandatory. The province covers everything but the vehicle(s)]. Basic auto insurance is mandatory throughout Canada with each province's government determining which benefits are included as minimum required auto insurance coverage and which benefits are options available for those seeking additional coverage. Accident benefits coverage is mandatory everywhere except for Newfoundland and Labrador. All provinces in Canada have some form of no-fault insurance available to accident victims. The difference from province to province is the extent to which tort or no-fault is emphasized. International drivers entering Canada are permitted to drive any vehicle their licence allows for the 3-month period for which they are allowed to use their international licence. International laws provide visitors to the country with an International Insurance Bond (IIB) until this 3-month period is over in which the international driver must provide themselves with Canadian Insurance. The IIB is reinstated every time the international driver enters the country. Damage to the driver's own vehicle is optional – one notable exception to this is in Saskatchewan, where SGI provides collision coverage (less than a $1000 deductible, such as a collision damage waiver) as part of its basic insurance policy. In Saskatchewan, residents have the option to have their auto insurance through a tort system but less than 0.5% of the population have taken this option.
GermanyInternational Motor Insurance Card (IVK)
Since 1939, it has been compulsory to have third party personal insurance before keeping a motor vehicle in all federal states of Germany. In addition, every vehicle owner is free to take out a comprehensive insurance policy. All types of car insurances are provided by several private insurers. The amount of insurance contribution is determined by several criteria, like the region, the type of car or the personal way of driving.
The minimum coverage defined by German law for car liability insurance / third party personal insurance is: 7.5 million euro for bodily injury (damage to people), 1 million euro for property damage and 50,000 euro for financial/fortune loss which is in no direct or indirect coherence with bodily injury or property damage. Insurance companies usually offer all-in/combined single limit insurances of 50 Million Euro or 100 Million Euro (about 141 Million Dollar) for bodily injury, property damage and other financial/fortune loss (usually with a bodily injury coverage limitation of 8 to 15 million euro for each bodily injured person).
Third-party vehicle insurance is mandatory for all vehicles in Hungary. No exemption is possible by money deposit. The premium covers all damage up to HUF 500M (about €1.8M) per accident without deductible. The coverage is extended to HUF 1,250M (about €4.5M) in case of personal injuries. Vehicle insurance policies from all EU-countries and some non-EU countries are valid in Hungary based on bilateral or multilateral agreements. Visitors with vehicle insurance not covered by such agreements are required to buy a monthly, renewable policy at the border.
Third-party vehicle Insurance is a mandatory requirement in Indonesia and each individual car and motorcycle must be insured or the vehicle will not be considered legal. Therefore, a motorist cannot drive the vehicle until it is insured. Third Party vehicle insurance is included through a levy in the vehicle registration fee which is paid to government institution that known as "Samsat". Third-Party Vehicle Insurance is regulated under Act No. 34 Year 1964 Re: Road Traffic Accident Fund and merely covers Bodily injury, and managed by a SOE named PT. Jasa Raharja (Persero).
IndiaA Sample Vehicle Insurance Certificate in India
Auto Insurance in India deals with the insurance covers for the loss or damage caused to the automobile or its parts due to natural and man-made calamities. It provides accident cover for individual owners of the vehicle while driving and also for passengers and third party legal liability. There are certain general insurance companies who also offer online insurance service for the vehicle.
Auto Insurance in India is a compulsory requirement for all new vehicles used whether for commercial or personal use. The insurance companies have tie-ups with leading automobile manufacturers. They offer their customers instant auto quotes. Auto premium is determined by a number of factors and the amount of premium increases with the rise in the price of the vehicle. The claims of the Auto Insurance in India can be accidental, theft claims or third party claims. Certain documents are required for claiming Auto Insurance in India, like duly signed claim form, RC copy of the vehicle, Driving license copy, FIR copy, Original estimate and policy copy.
There are different types of Auto Insurance in India :
Private Car Insurance – In the Auto Insurance in India, Private Car Insurance is the fastest growing sector as it is compulsory for all the new cars. The amount of premium depends on the make and value of the car, state where the car is registered and the year of manufacture.
Two Wheeler Insurance – The Two Wheeler Insurance under the Auto Insurance in India covers accidental insurance for the drivers of the vehicle. The amount of premium depends on the current showroom price multiplied by the depreciation rate fixed by the Tariff Advisory Committee at the time of the beginning of policy period.
Commercial Vehicle Insurance – Commercial Vehicle Insurance under the Auto Insurance in India provides cover for all the vehicles which are not used for personal purposes, like the Trucks and HMVs. The amount of premium depends on the showroom price of the vehicle at the commencement of the insurance period, make of the vehicle and the place of registration of the vehicle. The auto insurance generally includes:
- Loss or damage by accident, fire, lightning, self ignition, external explosion, burglary, housebreaking or theft, malicious act.
- Liability for third party injury/death, third party property and liability to paid driver
- On payment of appropriate additional premium, loss/damage to electrical/electronic accessories
The auto insurance does not include:
- Consequential loss, depreciation, mechanical and electrical breakdown, failure or breakage
- When vehicle is used outside the geographical area
- War or nuclear perils and drunken driving.
The Road Traffic Act, 1933 requires all drivers of mechanically propelled vehicles in public places to have at least third-party insurance, or to have obtained exemption – generally by depositing a (large) sum of money with the High Court as a guarantee against claims. In 1933 this figure was set at £15,000. The Road Traffic Act, 1961 (which is currently in force) repealed the 1933 act but replaced these sections with functionally identical sections.
From 1968, those making deposits require the consent of the Minister for Transport to do so, with the sum specified by the Minister.
Those not exempted from obtaining insurance must obtain a certificate of insurance from their insurance provider, and display a portion of this (an insurance disc) on their vehicles windscreen (if fitted). The certificate in full must be presented to a police station within ten days if requested by an officer. Proof of having insurance or an exemption must also be provided to pay for the motor tax.
Those injured or suffering property damage/loss due to uninsured drivers can claim against the Motor Insurance Bureau of Ireland's uninsured drivers fund, as can those injured (but not those suffering damage or loss) from hit and run offences.
The law 990/1969 requires that each motor vehicle or trailer standing or moving on a public road have third party insurance (called RCA, Responsabilità civile per gli autoveicoli). Historically, a part of the certificate of insurance must be displayed on the windscreen of the vehicle. This latter requirement was revoked in 2015, when a national database of insured vehicles was built by the Insurance Company Association (ANIA, Associazione Nazionale Imprese Assicuratrici) and the National Transportation Authority (Motorizzazione Civile) to verify (by private citizens and public authorities) if a vehicle is insured. There is no exemption policy to this law disposition.
Driving without the necessary insurance for that vehicle is an offence that can be prosecuted by the police and fines range from 841 to 3,287 euros. Police forces also have the power to seize a vehicle that does not have the necessary insurance in place, until the owner of the vehicle pays a fine and signs a new insurance policy. The same provision is applied when the vehicle is standing on public road.
Minimal insurance policies covers only third parties (including the insured person and third parties carried with the vehicle, but not the driver, if the two do not coincide). Also the third parties, fire and theft are common insurance policies, while the all inclusive policies (kasko policy) which include also damages of the vehicle causing the accident or the injuries. It is also common to include a renounce clause of the insurance company to compensate the damages against the insured person in some cases (usually in case of DUI or other infringement of the law by the driver).
The victims of accident caused by non-insured vehicles could be compensated by the Road's Victim Warranty Fund (Fondo garanzia vittime della strada), which is covered by a fixed amount (2.5%, as 2015) of each RCA insurance premium.
Within New Zealand, the Accident Compensation Corporation (ACC) provides nationwide no-fault personal injury insurance. Injuries involving motor vehicles operating on public roads are covered by the Motor Vehicle Account, for which premiums are collected through levies on petrol and through vehicle licensing fees.
In Norway, the vehicle owner must provide the minimum of liability insurance for his vehicle(s) – of any kind. Otherwise, the vehicle is illegal to use. If a person drives a vehicle belonging to someone else, and has an accident, the insurance will cover for damage done. Note that the policy carrier can choose to limit the coverage to only apply for family members or person over a certain age.
Romanian law mandates Răspundere Auto Civilă, a motor-vehicle liability insurance for all vehicle owners to cover damages to third parties.
Motor-vehicle insurance is mandatory for all owners according to Russian legislation.
South Africa allocates a percentage of the money from fuel into the Road Accident Fund, which goes towards compensating third parties in accidents.
Each motor vehicle in a public road to have a third party insurance (called "Seguro de responsabilidad civil").
Police forces have the power to seize vehicles that do not have the necessary insurance in place, until the owner of the vehicle pays the fine and sign a new insurance policy. Driving without the necessary insurance for that vehicle is an offence that will be prosecuted by the police and will receive penalty. Same provision is applied when the vehicle is standing on public road.
The minimal insurance policies covers only third parties (included the insured person and third parties carried with the vehicle, but not the driver, if the two do not coincide). Also the third parties, fire and theft are common insurance policies.
The victims of accident caused by non-insured vehicles could be compensated by a Warranty Fund, which is covered by a fixed amount of each insurance premium.
Since 2013 it is possible to contract an insurance by days as is possible in countries such as Germany and England.
United Arab Emirates
When buying car insurance in the United Arab Emirates, traffic department require a 13-month insurance certificate each time you register or renew a vehicle registration.
United KingdomUninsured cars seized by Merseyside Police on display outside the force's headquarters in 2006
In 1930, the UK government introduced a law that required every person who used a vehicle on the road to have at least third-party personal injury insurance. Today, this UK law is defined by the Road Traffic Act 1988, (generally referred to as the RTA 1988 as amended) which was last modified in 1991. The Act requires that motorists either be insured, or have made a specified deposit (£500,000 in 1991) and keeps the sum deposited with the Accountant General of the Supreme Court, against liability for injuries to others (including passengers) and for damage to other persons' property, resulting from use of a vehicle on a public road or in other public places.
It is an offence to use a motor vehicle, or allow others to use it without insurance that satisfies the requirements of the Act. This requirement applies while any part of a vehicle (even if a greater part of it is on private land) is on the public highway. No such legislation applies on private land. However, private land to which the public have a reasonable right of access (for example, a supermarket car park during opening hours) is considered to be included within the requirements of the Act.
Police have the power to seize vehicles that do not appear to have necessary insurance in place. A driver caught driving without insurance for the vehicle he/she is in charge of for the purposes of driving, is liable to be prosecuted by the police and, upon conviction, will receive either a fixed penalty or magistrate's courts penalty.
The registration number of the vehicle shown on the insurance policy, along with other relevant information including the effective dates of cover are transmitted electronically to the UK's Motor Insurance Database (MID) which exists to help reduce incidents of uninsured driving in the territory. The Police are able to spot-check vehicles that pass within range of automated number plate recognition (ANPR) cameras, that can search the MID instantly. It should be noted, however, that proof of insurance lies entirely with the issue of a Certificate of Motor Insurance, or cover note, by an Authorised Insurer which, to be valid, must have been previously 'delivered' to the insured person in accordance with the Act, and be printed in black ink on white paper.
The insurance certificate or cover note issued by the insurance company constitutes the only legal evidence that the policy to which the certificate relates satisfies the requirements of the relevant law applicable in Great Britain, Northern Ireland, the Isle of Man, the Island of Guernsey, the Island of Jersey and the Island of Alderney. The Act states that an authorised person, such as a police officer, may require a driver to produce an insurance certificate for inspection. If the driver cannot show the document immediately on request, and evidence of insurance cannot be found by other means such as the MID, then the Police are empowered to seize the vehicle instantly.
The immediate impounding of an apparently uninsured vehicle replaces the former method of dealing with insurance spot-checks where drivers were issued with an HORT/1 (so-called because the order was form number 1 issued by the Home Office Road Traffic dept). This 'ticket' was an order requiring that within seven days, from midnight of the date of issue, the driver concerned was to take a valid insurance certificate (and usually other driving documents as well) to a police station of the driver's choice. Failure to produce an insurance certificate was, and still is, an offence. The HORT/1 was commonly known – even by the issuing authorities when dealing with the public – as a "Producer". As these are seldom issued now and the MID relied upon to indicate the presence of insurance or not, it is incumbent upon the insurance industry to accurately and swiftly update the MID with current policy details and insurers that fail to do so can be penalised by their regulating body.
Vehicles kept in the UK must now be continuously insured. This requirement arose following a change in the law in June 2011 when a regulation known as Continuous Insurance Enforcement (CIE) came into force. The effect of this was that in the UK a vehicle must have a valid insurance policy in force whether or not it is kept on public roads and whether or not it is driven.
Insurer, and Vehicle Excise Duty (VED) / licence data, are shared by the relevant authorities including the Police and this forms an integral part of the mechanism of CIE. All UK registered vehicles, including those that are exempt from VED (for example, Historic Vehicles and cars with low or zero emissions) are subject to the VED taxation application process. Part of this is a check on the vehicle's insurance. A physical receipt for the payment of VED was issued by way of a paper disc which, prior to 1 October 2014, meant that all motorists in the UK were required to prominently display the tax disc on their vehicle when it was kept or driven on public roads. This helped to ensure that most people had adequate insurance on their vehicles because insurance cover was required to purchase a disc, although the insurance must merely have been valid at the time of purchase and not necessarily for the life of the tax disc. To address the problems that arise where a vehicle's insurance was subsequently cancelled but the tax disc remained in force and displayed on the vehicle and the vehicle then used without insurance, the CIE regulations are now able to be applied as the Driver & Vehicle Licence Authority (DVLA) and the MID databases are shared in real-time meaning that a taxed but uninsured vehicle is easily detectable by both authorities and Traffic Police. Post 1 October 2014 it is no longer a requirement to display a vehicle excise licence (tax disc) on a vehicle. This has come about because the whole VED process can now be administered electronically and alongside the MID, doing away with the expense, to the UK Government, of issuing paper discs.
If a vehicle is to be "laid up" for whatever reason, a Statutory Off Road Notification (SORN) must be submitted to the DVLA to declare that the vehicle is off the public roads and will not return to them unless SORN is cancelled by the vehicle's owner. Once a vehicle has been declared 'SORN' then the legal requirement to insure it ceases, although many vehicle owners may desire to maintain cover for loss of or damage to the vehicle while it is off the road. A vehicle that is then to be put back on the road must be subject to a new application for VED and be insured. Part of the VED application requires an electronic check of the MID, in this way the lawful presence of a vehicle on the road for both VED and insurance purposes is reinforced. It follows that the only circumstances in which a vehicle can have no insurance is if it has a valid SORN; was exempted from SORN (as untaxed on or before 31/10/1998 and has had no tax or SORN activity since); is recorded as 'stolen and not recovered' by the Police; is between registered keepers; or is scrapped.
Road Traffic Act Only Insurance differs from Third Party Only Insurance (detailed below) and is not often sold, unless to underpin, for example, a corporate body wishing to self-insure above the requirements of the Act. It provides the very minimum cover to satisfy the requirements of the Act. Road Traffic Act Only Insurance has a limit of £1,000,000 for damage to third party property, while third party only insurance typically has a greater limit for third party property damage.
Motor insurers in the UK place a limit on the amount that they are liable for in the event of a claim by third parties against a legitimate policy. This can be explained in part by the Great Heck Rail Crash that cost the insurers over £22 million in compensation for the fatalities and damage to property caused by the actions of the insured driver of a motor vehicle that caused the disaster. No limit applies to claims from third parties for death or personal injury, however UK car insurance is now commonly limited to £20m for any claim or series of claims for loss of or damage to third party property caused by or arising out of one incident.
The minimum level of insurance cover generally available, and which satisfies the requirement of the Act, is called third party only insurance. The level of cover provided by Third party only insurance is basic, but does exceed the requirements of the act. This insurance covers any liability to third parties, but does not cover any other risks.
More commonly purchased is third party, fire and theft. This covers all third party liabilities and also covers the vehicle owner against the destruction of the vehicle by fire (whether malicious or due to a vehicle fault) and theft of the insured vehicle. It may or may not cover vandalism. This kind of insurance and the two preceding types do not cover damage to the vehicle caused by the driver or other hazards.
Comprehensive insurance covers all of the above and damage to the vehicle caused by the driver themselves, as well as vandalism and other risks. This is usually the most expensive type of insurance. Interestingly, it is custom in the UK for insurance customers to refer to their Comprehensive Insurance as "Fully Comprehensive" or popularly, "Fully Comp". This is a tautology as the word 'Comprehensive' means full.
Some classes of vehicle ownership, or use, are "Crown Exempt" from the requirement to be covered under the Act including vehicles owned or operated by certain councils and local authorities, national park authorities, education authorities, police authorities, fire authorities, health service bodies, the security services and vehicles used to or from Shipping Salvage purposes. Although exempt from the requirement to insure this provides no immunity against claims being made against them, so an otherwise Crown Exempt authority may chose to insure conventionally, preferring to incur the known expense of insurance premiums rather than accept the open-ended exposure of effectively, self-insuring under Crown Exemption.
The Motor Insurers' Bureau (MIB) compensates the victims of road accidents caused by uninsured and untraced motorists. It also operates the MID, which contain details of every insured vehicle in the country and acts as a means to share information between Insurance Companies.
Soon after the introduction of the Road Traffic Act in 1930, unexpected issues arose when motorists needed to drive a vehicle other than their own in genuine emergency circumstances. Volunteering to move a vehicle, for example, where another motorist had been taken ill or been involved in an accident, could lead to the 'assisting' driver being prosecuted for no insurance if the other car's insurance did not cover use by any driver. To alleviate this situation an extension to UK Car Insurances was introduced allowing a Policyholder to personally drive any other motor car not belonging to him/her and not hired to him/her under a hire purchase or leasing agreement. This extension of cover, known as "Driving Other Cars" (where it is granted) usually applies to the Policyholder only. The cover provided is for Third Party Risks only and there is absolutely no cover for loss of or damage to the vehicle being driven. This aspect of UK motor insurance is the only one that purports to cover the driving of a vehicle, not use.
On 1 March 2011 the European Court of Justice in Luxembourg ruled that gender could no longer be used by insurers to set car insurance premiums. The new ruling will come into action from December 2012.
Investigation into repair costs & fraudulent claims
In September 2012 it was announced that the Competition Commission had launched an investigation into the UK system for credit repairs and credit hire of an alternative vehicle leading to claims from third parties following an accident. Where their client is considered to be not at fault, Accident Management Companies will take over the running of their client's claim and arrange everything for them, usually on a 'No Win - No Fee' basis. It was shown that the insurers of the at-fault vehicle, were unable to intervene in order to have control over the costs that were applied to the claim by means of repairs, storage, vehicle hire, referral fees and personal injury. The subsequent cost of some items submitted for consideration has been a cause for concern over recent years as this has caused an increase in the premium costs, contrary to the general duty of all involved to mitigate the cost of claims. Also, the recent craze of "Cash for crash" has substantially raised the cost of policies. This is where two parties arrange a collision between their vehicles and one driver making excessive claims for damage and non existent injuries to themselves and the passengers that they had arranged to be "in the vehicle" at the time of the collision. Another recent development has seen crashes being caused deliberately by a driver "slamming" on their brakes so that the driver behind hits them, this is usually carried out at roundabout junctions, when the following driver is looking to the right for oncoming traffic and does not notice that the vehicle in front has suddenly stopped for no reason. The 'staging' of a motor collision on the Public Highway for the purpose of attempting an insurance fraud is considered by the Courts to be organised crime and upon conviction is dealt with as such.
United StatesMain article: Vehicle insurance in the United States
The regulations for vehicle insurance differ with each of the 50 US states and other territories, with each U.S. state having its own mandatory minimum coverage requirements (see separate main article). Each of the 50 U.S. states and the District of Columbia requires drivers to have insurance coverage for both bodily injury and property damage, but the minimum amount of coverage required by law varies by state. For example, minimum bodily injury liability coverage requirements range from $20,000 in Florida to $100,000 in Alaska and Maine, while minimum property damage liability requirements range from $5,000 (four states) to $25,000 (16 states).
Vehicle insurance can cover some or all of the following items:
- The insured party (medical payments)
- Property damage caused by the insured
- The insured vehicle (physical damage)
- Third parties (car and people, property damage and bodily injury)
- Third party, fire and theft
- In some jurisdictions coverage for injuries to persons riding in the insured vehicle is available without regard to fault in the auto accident (No Fault Auto Insurance)
- The cost to rent a vehicle if yours is damaged.
- The cost to tow your vehicle to a repair facility.
- Accidents involving uninsured motorists.
Different policies specify the circumstances under which each item is covered. For example, a vehicle can be insured against theft, fire damage, or accident damage independently.
If a vehicle is declared a total loss and the vehicle's market value is less than the amount that is still owed to the bank that is financing the vehicle, GAP insurance may cover the difference. Not all auto insurance policies include GAP insurance. GAP insurance is often offered by the finance company at time the vehicle is purchased.
An excess payment, also known as a deductible, is a fixed contribution that must be paid each time a car is repaired with the charges billed to an automotive insurance policy. Normally this payment is made directly to the accident repair "garage" (the term "garage" refers to an establishment where vehicles are serviced and repaired) when the owner collects the car. If one's car is declared to be a "write off" (or "totaled"), then the insurance company will deduct the excess agreed on the policy from the settlement payment it makes to the owner.
If the accident was the other driver's fault, and this fault is accepted by the third party's insurer, then the vehicle owner may be able to reclaim the excess payment from the other person's insurance company.
The excess itself can also be protected by a motor excess insurance policy.
A compulsory excess is the minimum excess payment the insurer will accept on the insurance policy. Minimum excesses vary according to the personal details, driving record and the insurance company. For example, young or inexperienced drivers and types of incident can incur additional compulsory excess charges.
To reduce the insurance premium, the insured party may offer to pay a higher excess (deductible) than the compulsory excess demanded by the insurance company. The voluntary excess is the extra amount, over and above the compulsory excess, that is agreed to be paid in the event of a claim on the policy. As a bigger excess reduces the financial risk carried by the insurer, the insurer is able to offer a significantly lower premium.
Basis of premium chargesMain article: auto insurance risk selection
Depending on the jurisdiction, the insurance premium can be either mandated by the government or determined by the insurance company, in accordance with a framework of regulations set by the government. Often, the insurer will have more freedom to set the price on physical damage coverages than on mandatory liability coverages.
When the premium is not mandated by the government, it is usually derived from the calculations of an actuary, based on statistical data. The premium can vary depending on many factors that are believed to affect the expected cost of future claims. Those factors can include the car characteristics, the coverage selected (deductible, limit, covered perils), the profile of the driver (age, gender, driving history) and the usage of the car (commute to work or not, predicted annual distance driven).
Because male drivers, especially younger ones, are on average often regarded as tending to be more aggressive, the premiums charged for policies on vehicles whose primary driver is male are often higher. This discrimination may be dropped if the driver is past a certain age.
On 1 March 2011, the European Court of Justice decided insurance companies who used gender as a risk factor when calculating insurance premiums were breaching EU equality laws. The Court ruled that car-insurance companies were discriminating against men. However, in some places, such as the UK, companies have used the standard practice of discrimination based on profession to still use gender as a factor, albeit indirectly. Professions which are more typically practised by men are deemed as being more risky even if they had not been prior to the Court's ruling while the converse is applied to professions predominant among women. Another effect of the ruling has been that, while the premiums for men have been lowered, they have been raised for women. This equalisation effect has also been seen in other types of insurance for individuals, such as life insurance.
Teenage drivers who have no driving record will have higher car insurance premiums. However, young drivers are often offered discounts if they undertake further driver training on recognized courses, such as the Pass Plus scheme in the UK. In the US many insurers offer a good-grade discount to students with a good academic record and resident-student discounts to those who live away from home. Generally insurance premiums tend to become lower at the age of 25. Some insurance companies offer "stand alone" car insurance policies specifically for teenagers with lower premiums. By placing restrictions on teenagers' driving (forbidding driving after dark, or giving rides to other teens, for example), these companies effectively reduce their risk.
Senior drivers are often eligible for retirement discounts, reflecting the lower average miles driven by this age group. However, rates may increase for senior drivers after age 65, due to increased risk associated with much older drivers. Typically, the increased risk for drivers over 65 years of age is associated with slower reflexes, reaction times, and being more injury-prone.
U.S. driving history
In most U.S. states, moving violations, including running red lights and speeding, assess points on a driver's driving record. Since more points indicate an increased risk of future violations, insurance companies periodically review drivers' records, and may raise premiums accordingly. Rating practices, such as debit for a poor driving history, are not dictated by law. Many insurers allow one moving violation every three to five years before increasing premiums. Accidents affect insurance premiums similarly. Depending on the severity of the accident and the number of points assessed, rates can increase by as much as twenty to thirty percent. Any motoring convictions should be disclosed to insurers, as the driver is assessed by risk from prior experiences while driving on the road.
Statistics show that married drivers average fewer accidents than the rest of the population so policy owners who are married often receive lower premiums than single persons.
The profession of the driver may be used as a factor to determine premiums. Certain professions may be deemed more likely to result in damages if they regularly involve more travel or the carrying of expensive equipment or stock or if they are predominant either among women or among men.
Two of the most important factors that go into determining the underwriting risk on motorized vehicles are: performance capability and retail cost. The most commonly available providers of auto insurance have underwriting restrictions against vehicles that are either designed to be capable of higher speeds and performance levels, or vehicles that retail above a certain dollar amount. Vehicles that are commonly considered luxury automobiles usually carry more expensive physical damage premiums because they are more expensive to replace. Vehicles that can be classified as high performance autos will carry higher premiums generally because there is greater opportunity for risky driving behavior. Motorcycle insurance may carry lower property-damage premiums because the risk of damage to other vehicles is minimal, yet have higher liability or personal-injury premiums, because motorcycle riders face different physical risks while on the road. Risk classification on automobiles also takes into account the statistical analysis of reported theft, accidents, and mechanical malfunction on every given year, make, and model of auto.
Some car insurance plans do not differentiate in regard to how much the car is used. There are however low-mileage discounts offered by some insurance providers. Other methods of differentiation would include: over-road distance between the ordinary residence of a subject and their ordinary, daily destinations.
Reasonable distance estimation
Another important factor in determining car-insurance premiums involves the annual mileage put on the vehicle, and for what reason. Driving to and from work every day at a specified distance, especially in urban areas where common traffic routes are known, presents different risks than how a retiree who does not work any longer may use their vehicle. Common practice has been that this information was provided solely by the insured person, but some insurance providers have started to collect regular odometer readings to verify the risk.
Cents Per Mile Now (1986) advocates classified odometer-mile rates, a type of usage-based insurance. After the company's risk factors have been applied, and the customer has accepted the per-mile rate offered, then customers buy prepaid miles of insurance protection as needed, like buying gallons of gasoline (litres of petrol). Insurance automatically ends when the odometer limit (recorded on the car's insurance ID card) is reached, unless more distance is bought. Customers keep track of miles on their own odometer to know when to buy more. The company does no after-the-fact billing of the customer, and the customer doesn't have to estimate a "future annual mileage" figure for the company to obtain a discount. In the event of a traffic stop, an officer could easily verify that the insurance is current, by comparing the figure on the insurance card to that on the odometer.
Critics point out the possibility of cheating the system by odometer tampering. Although the newer electronic odometers are difficult to roll back, they can still be defeated by disconnecting the odometer wires and reconnecting them later. However, as the Cents Per Mile Now website points out:
As a practical matter, resetting odometers requires equipment plus expertise that makes stealing insurance risky and uneconomical. For example, to steal 20,000 miles [32,200 km] of continuous protection while paying for only the 2000 in the 35000 to 37000 range on the odometer, the resetting would have to be done at least nine times, to keep the odometer reading within the narrow 2,000-mile [3,200 km] covered range. There are also powerful legal deterrents to this way of stealing insurance protection. Odometers have always served as the measuring device for resale value, rental and leasing charges, warranty limits, mechanical breakdown insurance, and cents-per-mile tax deductions or reimbursements for business or government travel. Odometer tampering, detected during claim processing, voids the insurance and, under decades-old state and federal law, is punishable by heavy fines and jail.
Under the cents-per-mile system, rewards for driving less are delivered automatically, without the need for administratively cumbersome and costly GPS technology. Uniform per-mile exposure measurement for the first time provides the basis for statistically valid rate classes. Insurer premium income automatically keeps pace with increases or decreases in driving activity, cutting back on resulting insurer demand for rate increases and preventing today's windfalls to insurers, when decreased driving activity lowers costs but not premiums.
In 1998, the Progressive Insurance company started a pilot program in Texas, in which drivers received a discount for installing a GPS-based device that tracked their driving behavior and reported the results via cellular phone to the company. Policyholders were reportedly more upset about having to pay for the expensive device than they were over privacy concerns. The program was discontinued in 2000. In following years many policies (including Progressive) have been trialed and successfully introduced worldwide into what are referred to as Telematic Insurance. Such 'telematic' policies typically are based on black-box insurance technology, such devices derive from stolen vehicle and fleet tracking but are used for insurance purposes. Since 2010 GPS-based and Telematic Insurance systems have become more mainstream in the auto insurance market not just aimed at specialised auto-fleet markets or high value vehicles (with an emphasis on stolen vehicle recovery). Modern GPS-based systems are branded as 'PAYD' Pay As You Drive insurance policies, 'PHYD' Pay How You Drive or since 2012 Smartphone auto insurance policies which utilise smartphones as a GPS sensor, e.g. . A detailed survey of the smartphone as measurement probe for insurance telematics is provided in 
The Progressive Corporation launched Snapshot to give drivers a customized insurance rate based on recording how, how much, and when their car is driven. Snapshot is currently available in 46 states plus the District of Columbia. Because insurance is regulated at the state level, Snapshot is currently not available in Alaska, California, Hawaii, and North Carolina. Driving data is transmitted to the company using an on-board telematic device. The device connects to a car's OnBoard Diagnostic (OBD-II) port (all petrol automobiles in the USA built after 1996 have an OBD-II.) and transmits speed, time of day and number of miles the car is driven. Cars that are driven less often, in less-risky ways, and at less-risky times of day, can receive large discounts. Progressive has received patents on its methods and systems of implementing usage-based insurance and has licensed these methods and systems to other companies.
Metromile also uses an OBDII-based system for their mileage-based insurance. They offer a true pay-per-mile insurance where behavior or driving style is not taken into account, and the user only pays a base rate along with a fixed rate per mile. The OBD-II device measures mileage and then transmits mileage data to servers. This is intended to be an affordable car insurance policy for low-mileage drivers. Metromile is currently only offering personal car insurance policies and is available in California, Oregon, Washington, and Illinois.
Insurance companies have started using credit ratings of their policyholders to determine risk. Drivers with good credit scores get lower insurance premiums, as it is believed that they are more financially stable, more responsible and have the financial means to better maintain their vehicles. Those with lower credit scores can have their premiums raised or insurance canceled outright. It has been shown that good drivers with spotty credit records could be charged higher premiums than bad drivers with good credit records.
The use of non-intrusive load monitoring to detect drunk driving and other risky behaviors has been proposed. A US patent application combining this technology with a usage based insurance product to create a new type of behavior based auto insurance product is currently open for public comment on peer to patent. See Behavior-based safety. Behaviour based Insurance focusing upon driving is often called Telematics or Telematics2.0 in some cases monitoring focus upon behavioural analysis such as smooth driving.
|The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (September 2012) (Learn how and when to remove this template message)|
Auto repair insurance is an extension of car insurance available in all 50 of the United States that covers the natural wear and tear on a vehicle, independent of damages related to a car accident.
Some drivers opt to buy the insurance as a means of protection against costly breakdowns unrelated to an accident. In contrast to more standard and basic coverages such as comprehensive and collision insurance, auto repair insurance does not cover a vehicle when it is damaged in a collision, during a natural disaster or at the hands of vandals.
For many it is an attractive option for protection after the warranties on their cars expire.
Providers can also offer sub-divisions of auto repair insurance. There is standard repair insurance which covers the wear and tear of vehicles, and naturally occurring breakdowns. Some companies will only offer mechanical breakdown insurance, which only covers repairs necessary when breakable parts need to be fixed or replaced. These parts include transmissions, oil pumps, pistons, timing gears, flywheels, valves, axles and joints.
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- How Car Insurance Works at HowStuffWorks
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An excess is an amount you may need to pay towards a claim. There are different types of excess that may apply, based on your:
- Chosen excess
- Any special conditions, for example driver history or car type
To find out which excess type applies to you, please refer to your policy document or view your policy in your Self Service Centre account
In the event of a claim, you may need to pay an excess if:
- You’re the driver who’s considered at-fault
- There’s no other driver involved, for example a hail storm
- You’re unable to provide the details of the person at-fault
You may not need to pay an excess if:
- You can provide the name and address of the person we agree is at-fault
- You’re claiming only for damage to glass/sunroof and have the Windscreen/Glass cover option on your policy
- You’ve selected a $0 excess
For general information about excess, please read our Premium, Excess and Discounts Guide